{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:06:29Z","timestamp":1783933589928,"version":"3.55.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T00:00:00Z","timestamp":1782432000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Accurate subtyping of primary aldosteronism (PA) via adrenal venous sampling (AVS) is pivotal for guiding treatment decisions. However, the optimal AVS approach\u2014simultaneous versus sequential bilateral sampling\u2014remains controversial, necessitating a rigorous evaluation of diagnostic consistency between these 2 techniques.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive PA patients who underwent bilateral simultaneous unstimulated AVS via the antecubital vein between December 2024 and January 2026 were prospectively enrolled. Blood samples were collected from the bilateral adrenal veins and a peripheral vein at baseline (t0), 5\u2005min (t5), and 15\u2005min (t15) after catheterization. Sequential AVS was simulated by sampling the right adrenal vein (RAV) at t0 and the left adrenal vein (LAV) at either t5 or t15. Cortisol and aldosterone concentrations, the selectivity index, and the lateralization index (LI) were measured for all samples. Diagnostic concordance between sampling approaches was assessed using the intraclass correlation coefficient (ICC) and Kappa statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 55 eligible patients were included in the final analysis. Cortisol levels exhibited a significant gradual decline over time (P &amp;lt; .05 for t0 vs. t5), with substantial temporal variability in LI observed throughout the sampling process. ICC analysis demonstrated excellent agreement for LI among simultaneous AVS measurements at different time points (ICC = 0.840, 95% CI: 0.764-0.895), whereas agreement was lower between simultaneous and simulated sequential AVS (ICC = 0.680, 95% CI: 0.593-0.756 for t5 vs. t0-t5; ICC = 0.707, 95% CI: 0.560-0.820 for t15 vs. t0-t15). Kappa statistics confirmed superior diagnostic concordance for simultaneous AVS at a 5-min interval (agreement = 85.5%, Kappa = 0.768) compared with longer sampling intervals or sequential AVS, with notably poor concordance observed in patients with bilateral PA. Sequential AVS showed systematic differences in LI estimates, with underestimation in right-dominant unilateral PA and overestimation in left-dominant UPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Sequential AVS may be subject to bias due to stress-related cortisol changes over time, whereas simultaneous AVS provides better diagnostic concordance. Simultaneous AVS remains the gold standard for optimal precision, though sequential AVS is a viable alternative when simultaneous cannulation is not possible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejendo\/lvag116","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T11:53:05Z","timestamp":1782388385000},"page":"77-85","source":"Crossref","is-referenced-by-count":0,"title":["Sampling variability and concordance between sequential and simultaneous adrenal venous sampling in primary aldosteronism subtype diagnosis"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4677-9841","authenticated-orcid":false,"given":"Shaomin","family":"Shi","sequence":"first","affiliation":[{"name":"Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , 139 JingzhouStreet, Xiangyang, Hubei 441000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luhong","family":"Li","sequence":"additional","affiliation":[{"name":"Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , 139 JingzhouStreet, Xiangyang, Hubei 441000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangyu","family":"Shen","sequence":"additional","affiliation":[{"name":"Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , 139 JingzhouStreet, Xiangyang, Hubei 441000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junwei","family":"Wen","sequence":"additional","affiliation":[{"name":"Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , 139 JingzhouStreet, Xiangyang, Hubei 441000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghe","family":"Wang","sequence":"additional","affiliation":[{"name":"Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , 139 JingzhouStreet, Xiangyang, Hubei 441000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junxia","family":"Wu","sequence":"additional","affiliation":[{"name":"Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , 139 JingzhouStreet, Xiangyang, Hubei 441000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingan","family":"Li","sequence":"additional","affiliation":[{"name":"Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , 139 JingzhouStreet, Xiangyang, Hubei 441000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,26]]},"reference":[{"issue":"5","key":"2026071304214595000_lvag116-B1","doi-asserted-by":"publisher","first-page":"1889","DOI":"10.1210\/jc.2015-4061","article-title":"The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline","volume":"101","author":"Funder","year":"2016","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2026071304214595000_lvag116-B2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.7326\/M20-0065","article-title":"The unrecognized prevalence of primary aldosteronism: a cross-sectional study","volume":"173","author":"Brown","year":"2020","journal-title":"Ann Intern Med"},{"issue":"3","key":"2026071304214595000_lvag116-B3","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1161\/HYPERTENSIONAHA.106.086116","article-title":"Is there an unrecognized epidemic of primary aldosteronism? 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