title: Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling in primary aldosteronism.
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.
authors.affiliation: Department of Physiology, Georgia Health Sciences University, Augusta, GA, USA.
authors.forename: Silvia
authors.initials: S
authors.lastname: Monticone
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.forename: Gilberta
authors.initials: G
authors.lastname: Giacchetti
authors.forename: Andrea
authors.initials: A
authors.lastname: Viola
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.forename: Masataka
authors.initials: M
authors.lastname: Kudo
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Iwakura
authors.forename: Yoshikiyo
authors.initials: Y
authors.lastname: Ono
authors.forename: Federica
authors.initials: F
authors.lastname: Turchi
authors.forename: Enrico
authors.initials: E
authors.lastname: Paci
authors.forename: Franco
authors.initials: F
authors.lastname: Veglio
authors.forename: Marco
authors.initials: M
authors.lastname: Boscaro
authors.forename: William
authors.initials: W
authors.lastname: Rainey
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
authors.forename: Paolo
authors.initials: P
authors.lastname: Mulatero
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply* / Q000187:drug effects; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D000450:Aldosterone / Q000097:blood*; D002404:Catheterization; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis*; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone