AVS Calculator — Adrenal Vein Sampling

Patient

Patient Name / Initials

MRN

Protocol

Units

Aldosterone

Cortisol

Data Entry

Inferior Vena Cava (IVC) Peripheral Reference

Sample	Aldo (pg/mL)	Cortisol (µg/dL)	A/C Ratio	Incl.

Avg A/C (included) —

Right Adrenal Vein Samples

Sample	Aldo (pg/mL)	Cortisol (µg/dL)	A/C Ratio	Incl.

Avg A/C (included) —

Left Adrenal Vein Samples

Sample	Aldo (pg/mL)	Cortisol (µg/dL)	A/C Ratio	Incl.

Avg A/C (included) —

Results

Enter aldosterone and cortisol values to calculate results.

Dominant Side

—

Selectivity Index (SI) Threshold: ≥ 2.0

Right SI

— No data

Left SI

— No data

Lateralization Index (LI) Threshold: ≥ 4.0

LI (Higher ÷ Lower A/C)

— No data

Contralateral Suppression (CSI) Threshold: < 1.0

CSI (Contralateral ÷ IVC A/C)

— No data

Reference Thresholds

SI (unstimulated)≥ 2.0

SI (cosyntropin-stimulated)≥ 3.0

LI lateralized≥ 4.0

LI borderline2.0 – 3.9

LI bilateral< 2.0

CSI suppression< 1.0

References

Funder JW, Carey RM, Mantero F, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889–1916.
Primary source for SI, LI, and CSI thresholds used in this calculator.
Adler GK, Stowasser M, Correa RR, et al. Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2025;110(9):2453–2495. doi:10.1210/clinem/dgaf284
Most recent Endocrine Society update reaffirming AVS as gold standard for lateralization.
Rossi GP, Auchus RJ, Brown M, et al. An Expert Consensus Statement on the Use of Adrenal Vein Sampling for the Subtyping of Primary Aldosteronism. Hypertension. 2014;63(1):151–160. doi:10.1161/HYPERTENSIONAHA.113.02097
International expert consensus on AVS protocols and selectivity/lateralization criteria.
Vonend O, Ockenfels N, Gao X, et al. Clinical impact of strict criteria for selectivity and lateralization in adrenal vein sampling. Eur J Endocrinol. PMID: 27376419
Retrospective review of 73 AVS procedures validating strict SI and LI cutoffs.

Disclaimer: This tool is intended to support — not replace — clinical judgment. Threshold values may vary by institution and protocol; this calculator applies the most widely cited Endocrine Society thresholds. Results must always be interpreted by a qualified clinician in the context of the patient's full clinical picture, including imaging, biochemistry, comorbidities, and surgical candidacy. This calculator does not constitute medical advice and should not be used as the sole basis for clinical decision-making.