TY - JOUR
T1 - Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling in primary aldosteronism
AU - Monticone, Silvia
AU - Satoh, Fumitoshi
AU - Giacchetti, Gilberta
AU - Viola, Andrea
AU - Morimoto, Ryo
AU - Kudo, Masataka
AU - Iwakura, Yoshitsugu
AU - Ono, Yoshikiyo
AU - Turchi, Federica
AU - Paci, Enrico
AU - Veglio, Franco
AU - Boscaro, Marco
AU - Rainey, William
AU - Ito, Sadayoshi
AU - Mulatero, Paolo
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012/4
Y1 - 2012/4
N2 - 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.
AB - 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.
KW - adrenal vein sampling
KW - aldosterone
KW - aldosterone-producing adenoma
KW - endocrine hypertension
KW - primary aldosteronism
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U2 - 10.1161/HYPERTENSIONAHA.111.189548
DO - 10.1161/HYPERTENSIONAHA.111.189548
M3 - Article
C2 - 22331382
AN - SCOPUS:84858701478
VL - 59
SP - 840
EP - 846
JO - Hypertension
JF - Hypertension
SN - 0194-911X
IS - 4
ER -