Adrenal vein sampling (AVS) is considered the reference standard for subtyping primary aldosteronism. In addition to aldosterone, cortisol concentration is also measured to confirm the successful cannulation of the adrenal veins. Interventional radiologists routinely administer intravenous anxiolytic medications during lengthy procedures. Sedation may reduce cortisol production and its use is not standardized in AVS. We aimed to characterize the impact of sedation on plasma cortisol and aldosterone concentrations, cannulation success, and rates of lateralization during unstimulated AVS. Our findings suggest that midazolam and fentanyl administered in doses for moderate procedural sedation can lead to a clinically significant reduction in cortisol concentration during unstimulated adrenal vein sampling, with lower selectivity indexes and fewer perceived successful cannulations.
