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Adrenal venous sampling in primary aldosteronism: cosyntropin infusion increases the success rate of the procedure but can mask the lateralization of aldosterone secretion

Extract

Background: Adrenal venous sampling (AVS) in primary aldosteronism (PA) enables to identify the patients with unilateral form of the disease who can profit from adrenalectomy. Based on the available evidence, it is not clear whether to perform AVS at rest under physiological conditions or following pharmacologic stimulation.

Purpose: To evaluate the effect of adrenal stimulation by adrenocorticotropin analogue cosyntropin on AVS results in patients with PA.

Methods: AVS was performed both at rest and during continuous cosyntropin infusion. AVS procedure was considered successful provided cortisol concentrations in both adrenal samples were at least three times higher compared to peripheral blood at rest, and at least five times higher during adrenal stimulation.

Cortisol corrected aldosterone concentration (AC) in adrenal samples was used to compare the aldosterone secretion between both adrenals. Lateralisation index (LI) was calculated as a ratio of AC (dominant adrenal) to AC (non-dominant adrenal). Lateralisation of aldosterone secretion without adrenal stimulation was defined by LI >4 or >2 provided the suppression of contralateral adrenal gland was present. With adrenal stimulation, lateralization of aldosterone secretion was defined by LI >4.