Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling in primary aldosteronism

Silvia Monticone, Fumitoshi Satoh, Gilberta Giacchetti, Andrea Viola, Ryo Morimoto, Masataka Kudo, Yoshitsugu Iwakura, Yoshikiyo Ono, Federica Turchi, Enrico Paci, Franco Veglio, Marco Boscaro, William Rainey, Sadayoshi Ito, Paolo Mulatero

Research output: Contribution to journalArticlepeer-review

65 Citations (Scopus)

Abstract

Adrenal vein sampling (AVS) is fundamental for subtype diagnosis in patients with primary aldosteronism. AVS protocols vary between centers, especially for diagnostic indices and for use of adrenocorticotropic hormone (ACTH) stimulation. We investigated the role of both continuous ACTH infusion and bolus on the performance and interpretation of AVS in a sample of 76 patients with confirmed primary aldosteronism. In 36 primary aldosteronism patients, AVS was performed both under basal conditions and after continuous ACTH infusion, and in 40 primary aldosteronism patients, AVS was performed both under basal conditions and after ACTH IV bolus. Both ACTH protocols determined an increase in the rate of successful cannulation of the adrenal veins. Both ACTH infusion and bolus determined a significant increase in selectivity index for the right adrenal vein and ACTH bolus for the left adrenal vein. Lateralization index was not significantly different after continuous ACTH infusion and IV bolus. In 88% and 78% of the patients, the diagnosis obtained was the same before and after ACTH infusion and IV bolus, respectively. However, the reproducibility of the diagnosis was reduced using less stringent criteria for successful cannulation of the adrenal veins. This study shows that ACTH use during AVS may be of help for centers with lower success rates, because a successful adrenal cannulation is more easily obtained with this protocol; moreover, this technique performs at least as well as the unstimulated strategy and in some cases may be even better. Stringent criteria for cannulation should be used to have a high consistency of the diagnosis.

Original languageEnglish
Pages (from-to)840-846
Number of pages7
JournalHypertension
Volume59
Issue number4
DOIs
Publication statusPublished - 2012 Apr

Keywords

  • adrenal vein sampling
  • aldosterone
  • aldosterone-producing adenoma
  • endocrine hypertension
  • primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine

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