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Endocrinol Diabetes Metab. 2019 Mar 7;2(2):e00066. doi: 10.1002/edm2.66. eCollection 2019 Apr.

Adrenal vein sampling with and without cosyntropin stimulation for detection of surgically remediable aldosteronism.

Author information

1
Department of Radiology UConn Health Farmington Connecticut.
2
Department of Radiology and Biomedical Imaging Yale University New Haven Connecticut.
3
Department of Medicine, Division of Endocrinology and Neag Comprehensive Cancer Center UConn Health Farmington Connecticut.
4
Department of Radiology The Johns Hopkins Hospital Baltimore Maryland.
5
Department of Clinical and Translational Science Biostatistics Center Farmington Connecticut.
6
Department of Urology Hartford Hospital Hartford Connecticut.

Abstract

Context and Objective:

Bilateral adrenal vein sampling (AVS), the diagnostic standard for identifying surgically remediable aldosteronism (SRA), is commonly performed after cosyntropin stimulation (post-ACTHstim). The role of AVS without cosyntropin stimulation (pre-ACTHstim) has not been established. The selectivity index (SI), the adrenal vein (av) serum cortisol concentration divided by that in a peripheral vein, confirms av sampling. The minimally acceptable SI is controversial. The objectives of this study were to determine the role of pre-ACTHstim AVS and a predetermined SI.

Design:

Using biochemical cure as the endpoint, we performed a retrospective head-to-head comparison of pre-ACTHstim AVS to post-ACTHstim AVS. The specificity of a predetermined minimum SI of 1.5 in pre-ACTHstim AVS was determined.

Patients:

At a regional AVS referral centre, we analysed 32 patients who had undergone simultaneous bilateral AVS both pre- and post-ACTHstim and had returned for postadrenalectomy evaluation.

Measurements:

Simultaneous bilateral AVS was performed with measurements of venous concentrations of aldosterone and cortisol. End points were postadrenalectomy plasma renin activity, serum aldosterone concentration, and number of antihypertensive medications.

Results:

All 32 patients achieved a biochemical cure following adrenalectomy. The two AVS protocols were complementary. Notably, seven patients (22%; CI = 11-38) were found to have SRA by a lateralization index (LI) > 4 on the pre-ACTHstim AVS, but not on the post-ACTHstim AVS. SI pre-ACTHstim was divided into tertiles. Specificity was 100% in all.

Conclusions:

Simultaneous bilateral AVS performed both pre-ACTHstim and post-ACTHstim maximizes SRA identification. A SI of 1.5 pre-ACTHstim does not reduce specificity.

KEYWORDS:

adrenal vein sampling; adrenalectomy; aldosterone; hyperaldosteronism

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