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In this retrospective study, we aimed to estimate the influence of fluctuating peripheral plasma cortisol concentration (PCC) on the success rate of non-stimulated adrenal venous sampling (AVS) and to demonstrate its fluctuating pattern. Overall, 107 consecutive patients with primary aldosteronism undergoing AVS between July 2015–January 2017 were included. The peripheral vein was sampled at 4 separate time points during the procedure: after femoral puncture, during left adrenal sampling, during right adrenal sampling, and before procedural ending. The selectivity index (SI) was calculated using the highest, the lowest, and the simultaneous sampled peripheral PCC. The highest and lowest peripheral PCC significantly differed ( p  < 0.001) ranging from a 113% increase to a 55% decrease, respectively, and significant correlation between the degree of the peripheral PCC fluctuation and the inter-sampling time length was found (p < 0.001). There was significant difference in the success rate of the groups using different peripheral PCC: highest and lowest (SI cutoff value 2 and 3), highest and simultaneous (2 and 3), and lowest and simultaneous (3). Altogether, we found significant variation of the peripheral PCC during AVS and the success rate for non-stimulated AVS altered significantly using the peripheral PCC at different time points.

The influence of the peripheral cortisol fluctuation on the success rate of adrenal venous sampling