270 - Utility of Preoperative Labs in Primary Aldosteronism Patients Undergoing Adrenal Venous Sampling

Tuesday, April 14, 2026

3:45 PM - 3:54 PM ET

Presenting Author(s)

AM

Ahmad Maaly, MD

Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center/Harvard Medical School, United States

Author/Co-author(s)

Oussama Metrouh, MD (he/him/his)

Post- doctorate Research Fellow
Beth Israel Deaconess Medical Center, United States
Mohammed Elkholy, MD

Postdoctoral research fellow
The Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America, United States
MF

Mohamed Farghaly, MD

Postdoctoral research fellow
The Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America., United States
Marwan H. Moussa, MD

Vascular and Interventional Radiologist
Beth Israel Deaconess Medical Center, United States

Purpose: To identify the incidence of hypokalemia and unsuppressed renin on the day of adrenal venous sampling and their impact on procedural diagnostic accuracy.

Materials and Methods: After obtaining IRB approval, we retrospectively reviewed patients with primary aldosteronism (PA) who underwent adrenal vein sampling (AVS) between June 10, 2020, and January 31, 2025. Pre-procedural

laboratory values collected on the day of AVS included potassium and plasma renin activity (PRA). Additionally, we gathered the most recent potassium and PRA recorded prior to the day of the

procedure. Hypokalemia was defined as potassium < 3.5 mEq/L and unsuppressed renin was defined as >PRA ≥ 1 ng/mL/hr. Descriptive statistics were used to summarize the data. Patients who underwent

repeat AVS were analyzed separately to assess whether hypokalemia or unsuppressed renin influenced the lateralization of the initial AVS.

Results: A total of 253 patients were included in the study. Of these, 243 patients had their potassium levels measured on the day of AVS, with 56 (23.0%) presenting with hypokalemia. Among patients who were hypokalemic on the day of AVS, 31 (55.4%) had a normal potassium level in their most recent

measurement prior to the day of the procedure. Additionally, 227 patients had their renin levels measured on the day of AVS, and 28 (12.3%) had unsuppressed renin. Among patients who had an unsuppressed renin on the day of AVS, 13 (46.4%) had a suppressed renin level in their most recent measurement prior to the day of the procedure. Technical success was achieved in 245 patients (96.8%). Repeat AVS was performed in 13 patients. Among these, 5 had hypokalemia and 2 had an unsuppressed renin in the first AVS. Notably, two patients initially lateralized to one side when hypokalemic (K= 2.8 mEq/L) and with unsuppressed renin

(PRA= 1.68 ng/mL/hr) but lateralized to the opposite side after normalization of potassium (K= 3.6 mEq/L) and suppression of renin (PRA= 0.7 ng/mL/hr).

Conclusion: Our study found that a remarkable proportion of patients undergoing AVS had either hypokalemia or unsuppressed renin levels on the day of the procedure. These findings highlight the need for potassium and renin testing on the day of the procedure. Additionally, hypokalemia and unsuppressed renin may influence AVS lateralization outcomes. Further research is needed to validate these findings.