Surgical decision-making and referral patterns for adrenal vein sampling in primary aldosteronism: a national survey of endocrine surgeons
- 1University of Miami Leonard M. Miller School of Medicine , , ,
- 2Division of Endocrinology, Diabetes and Metabolism, University of Miami Health , , ,
Abstract
Background: This study aimed to discover and explore factors associated with endocrine surgeons’ (ES) referral patterns to Interventional Radiologists (IR) for adrenal vein sampling (AVS) for patients with primary aldosteronism (PA).
Methods: Following IRB approval, an electronic survey was distributed to members of the American Association of Endocrine Surgeons (AAES). This cross-sectional, descriptive survey was designed to generate hypotheses about AVS referral behavior rather than test prespecified causal relationships. Data collected included demographics, practice type, referral patterns, opinions on PA management, AVS utilization, confidence levels in AVS and Interventional Radiology (IR) proceduralists, and satisfaction with AVS results.
Results: 107 of 806 AAES members responded, 100 (93.5%) of which were ES. Of those surveyed, 45% (n=48) had 10+ years of practice experience, with 61% (n=74) at academic centers. Specialists managed 7.54 (± 5.71) PA patients per year. Among these surgeons, 71% reported “always” ordering AVS for PA, while 28% stated they “sometimes” ordered AVS. If bilateral adrenal nodules were identified on imaging, 100% of surgeons referred patients for AVS, whereas 78% referred patients with unilateral adrenal lesions. Among this group, 56% reported they trusted their IR physician of choice to perform AVS whereas 31% replied they trusted the associated IR group. AAES respondents “always” referred patients to local academic centers (71%), and “never” referred patients to local private IR groups (75%) or distant academic centers (75%). Among respondents, 83% were satisfied with AVS results.
Conclusions: AVS plays a central role in surgical decision-making for primary aldosteronism. Endocrine surgeons (ES) demonstrate strong referral patterns favoring individual interventional radiologists at local academic centers, with referral behavior affected by institutional context, trust in proceduralists and perceptions of procedural standardization. These findings reflect self-reported referral patterns among AAES members and may not capture actual observed clinical behavior.
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BibTeX
@article{neff2026surgical,
title = {{Surgical decision-making and referral patterns for adrenal vein sampling in primary aldosteronism: a national survey of endocrine surgeons}},
author = {Marisela Neff and Konrad Kozlowski and Chloe Issa and Anmol Patel and Jack Lin and Hannah Clode and Thomas Pennix and Zeina Hannoush and Alejandro Ayala and John I. Lew and Zoe A. Miller},
journal = {Frontiers in endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1909164},
url = {https://europepmc.org/article/PMC/PMC13670166},
note = {CC BY},
}
RIS
TY - JOUR
TI - Surgical decision-making and referral patterns for adrenal vein sampling in primary aldosteronism: a national survey of endocrine surgeons
AU - Marisela Neff
AU - Konrad Kozlowski
AU - Chloe Issa
AU - Anmol Patel
AU - Jack Lin
AU - Hannah Clode
AU - Thomas Pennix
AU - Zeina Hannoush
AU - Alejandro Ayala
AU - John I. Lew
AU - Zoe A. Miller
PY - 2026
DA - 2026/10/01
JO - Frontiers in endocrinology
DO - 10.3389/fendo.2026.1909164
UR - https://europepmc.org/article/PMC/PMC13670166
AB - Background: This study aimed to discover and explore factors associated with endocrine surgeons’ (ES) referral patterns to Interventional Radiologists (IR) for adrenal vein sampling (AVS) for patients with primary aldosteronism (PA). Methods: Following IRB approval, an electronic survey was distributed to members of the American Association of Endocrine Surgeons (AAES). This cross-sectional, descriptive survey was designed to generate hypotheses about AVS referral behavior rather than test prespecified causal relationships. Data collected included demographics, practice type, referral patterns, opinions on PA management, AVS utilization, confidence levels in AVS and Interventional Radiology (IR) proceduralists, and satisfaction with AVS results. Results: 107 of 806 AAES members responded, 100 (93.5%) of which were ES. Of those surveyed, 45% (n=48) had 10+ years of practice experience, with 61% (n=74) at academic centers. Specialists managed 7.54 (± 5.71) PA patients per year. Among these surgeons, 71% reported “always” ordering AVS for PA, while 28% stated they “sometimes” ordered AVS. If bilateral adrenal nodules were identified on imaging, 100% of surgeons referred patients for AVS, whereas 78% referred patients with unilateral adrenal lesions. Among this group, 56% reported they trusted their IR physician of choice to perform AVS whereas 31% replied they trusted the associated IR group. AAES respondents “always” referred patients to local academic centers (71%), and “never” referred patients to local private IR groups (75%) or distant academic centers (75%). Among respondents, 83% were satisfied with AVS results. Conclusions: AVS plays a central role in surgical decision-making for primary aldosteronism. Endocrine surgeons (ES) demonstrate strong referral patterns favoring individual interventional radiologists at local academic centers, with referral behavior affected by institutional context, trust in proceduralists and perceptions of procedural standardization. These findings reflect self-reported referral patterns among AAES members and may not capture actual observed clinical behavior.
SN - 1664-2392
ER -