scholarly journals Comparison of Bolus and Continuous Infusion of Adrenocorticotropic Hormone During Adrenal Vein Sampling

2021 ◽  
Vol 12 ◽  
Author(s):  
Jinbo Hu ◽  
Jiangqiong Chen ◽  
Qingfeng Cheng ◽  
Ying Jing ◽  
Jun Yang ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Adrenocorticotropic Hormone ◽  
Tertiary Hospital ◽  
Adrenal Vein ◽  
Acth Stimulation ◽  
Adrenal Vein Sampling ◽  
Successful Cannulation ◽  
Infusion Group ◽  
Biochemical Remission ◽  
Cannulation Success

BackgroundAdrenocorticotropic hormone (ACTH) is widely used in adrenal vein sampling (AVS) and can be administered as a bolus injection or continuous infusion. The optimal administration method has not been determined. We aimed to compare the effects of ACTH bolus with infusion on cannulation success, lateralization assessment and adverse events (AEs).MethodsRetrospectively collected data from patients with primary aldosteronism who underwent AVS with ACTH at a tertiary hospital in China. Rate of successful cannulation, lateralization index (LI), complete biochemical remission and AEs related to AVS were analyzed.ResultsThe study included 80 patients receiving ACTH bolus and 94 receiving infusions. The rate of successful cannulation was comparable between bolus and infusion groups (75/80, 93.4% vs 88/94, 93.6%). In those with successful cannulation, the bolus group had a higher selectivity index than the infusion group, while LI [6.4(1.8-17.5) vs. 7.6(2.0-27.8), P=0.48] and rate of complete biochemical remission (43/44, 97.7% vs 53/53, 100%, P=0.45) did not significantly differ between the two groups. One in the bolus and one patient in the infusion group had adrenal vein rupture but they recovered with conservative treatment. The bolus group reported more transient AEs such as palpitation (52.9% vs 2.2%) and abdominal discomfort (40.0% vs 2.2%) than the infusion group.ConclusionsDue to their similar effects on cannulation success and lateralization, but a lower rate of transient AEs in the infusion group, the continuous infusion method should be recommended for ACTH stimulation in AVS.

scholarly journals Adrenal Vein Sampling to Distinguish Between Unilateral and Bilateral Primary Hyperaldosteronism: To ACTH Stimulate or Not?

2020 ◽  
Vol 9 (5) ◽  
pp. 1447
Author(s):  
Tae-Yon Sung ◽  
Wilson Mawutor Alobuia ◽  
Monica Varun Tyagi ◽  
Chandrayee Ghosh ◽  
Electron Kebebew
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Primary Hyperaldosteronism ◽  
Adrenal Vein ◽  
Acth Stimulation ◽  
Adrenal Vein Sampling ◽  
Successful Cannulation ◽  
Unilateral Disease ◽  
The Right ◽  
Lateralization Index ◽  
Prospective Database

The aim of this study is to determine the accuracy of adrenal vein sampling (AVS) with and without adrenocorticotropic hormone (ACTH) stimulation to distinguish between unilateral and bilateral primary hyperaldosteronism (PA). Retrospective analysis of a prospective database from a referral center between 1984 and 2009, 76 patients had simultaneous cannulation of bilateral adrenal veins and AVS with and without ACTH stimulation. All patients had adrenalectomies. The selectivity index (SI, cut-off value ≥2) was used for confirmation of successful cannulation of the adrenal vein. The lateralization index (LI, cut-off value >2 and >4) was used for distinguishing between unilateral and bilateral PA. The SI ratio was higher with ACTH stimulation compared to without for the right adrenal vein (p = 0.027). The LI > 2 ratio was higher with ACTH stimulation compared to without (p = 0.007). For the LI > 4 ratio, there was no difference between with and without ACTH stimulation (p = 0.239). However, for a LI > 4, 7 patients (9.2%) were not lateralized with ACTH stimulation, but they did lateralize without ACTH stimulation. AVS with ACTH stimulation is associated with a higher SI ratio compared to AVS without ACTH stimulation. However, when using LI > 4 for AVS, samples without ACTH stimulation should also be included to detect a subset of patients with unilateral disease that are not detected with ACTH stimulation.

scholarly journals Effect of Adrenocorticotropic Hormone Stimulation During Simultaneous Bilateral Adrenal Vein Sampling in Primary Aldosteronism

2021 ◽  
Vol 53 (06) ◽  
pp. 364-370
Author(s):  
Wei Liu ◽  
Jingjing Zhang ◽  
Yaling Yang ◽  
Yinxin Jin ◽  
Zaizhao Li ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenocorticotropic Hormone ◽  
Base Excess ◽  
Serum Potassium Level ◽  
Adrenal Vein ◽  
Acth Stimulation ◽  
Adrenal Vein Sampling ◽  
Before And After ◽  
Carbon Dioxide Combining Power ◽  
Lateralization Index

AbstractThe aim of the study was to investigate the significance and influence of adrenocorticotropic hormone (ACTH) stimulation in primary aldosteronism (PA) patients with simultaneous bilateral adrenal vein sampling (AVS). All patients diagnosed with PA underwent simultaneous bilateral AVS with ACTH. In 95 patients, the post-ACTH SI significantly increased (p<0.001), and it gradually decreased from t10–t30 after ACTH stimulation (p<0.001). The unsuccessful catheterization decreased after ACTH stimulation. Time points within 20 min after ACTH stimulation were better for sampling, and the selectivity did not increase over longer periods. According to lateralization before and after ACTH stimulation, the patients could be divided into 3 groups (U, unilateral; B, bilateral): U/U , U/B or B/U, and B/B. Compared with the U/U group, in the U/B or B/U and B/B groups, the lateralization index (LI) was lower both at baseline and after ACTH stimulation (p<0.0001), the contralateral index (CLI) was higher after ACTH stimulation (p<0.003), the serum potassium level was higher (p<0.001), and the carbon dioxide combining power (CO2CP) and base excess (BE) levels were lower. In conclusion, in simultaneous bilateral AVS, ACTH stimulation had significant effects on increasing the catheterization selectivity. Lateralization change was observed after stimulation. After ACTH stimulation, fewer patients could be diagnosed with lateralized PA. Patients with consistent lateralized PA showed a more serious phenotype.

scholarly journals Physiologic variance of corticotropin affects diagnosis in adrenal vein sampling

2009 ◽  
Vol 160 (3) ◽  
pp. 459-463 ◽  
Author(s):  
Masayuki Tanemoto ◽  
Takehiro Suzuki ◽  
Michiaki Abe ◽  
Takaaki Abe ◽  
Sadayoshi Ito
Keyword(s):  
Low Dose ◽  
Standard Dose ◽  
Vena Cava ◽  
Adrenal Vein ◽  
Acth Stimulation ◽  
Adrenal Vein Sampling ◽  
High Prevalence ◽  
Design And Methods ◽  
Diagnostic Step ◽  
Cortisol Ratio

ObjectiveDifferentiating unilateral form from bilateral is a critical diagnostic step in primary aldosteronism (PA), for which adrenal vein sampling (AVS) is accepted to be the most reliable. However, variance of corticotropin could affect the diagnosis in AVS.Design and methodsWe conducted simultaneous bilateral AVS on ten biochemically diagnosed PA cases, and used the aldosterone-to-cortisol ratio (A/C) of the samples for the diagnosis. The diagnosis by AVS after a low-dose (0.1 μg) ACTH stimulation, which can provoke maximum-physiologic corticotropic response, was compared with those before the stimulation and after the standard-dose (250 μg) ACTH stimulation.ResultsIn half of the cases, the low-dose pre-stimulation affected the diagnosis. In four out of ten cases, the side-to-side ratios of A/C were changed in the basal/low-dose/standard-dose AVS as 6.62/2.46/0.63, 2.13/0.41/0.14, 1.88/2.38/2.40, and 1.96/2.27/1.90 respectively. In three out of ten cases, the adrenal vein to the matching inferior vena cava ratio of A/C was also changed across 1, the cut-off to indicate suppression of aldosterone secretion. Additionally, the confirmation of successful sampling was difficult in five out of ten and two out of ten cases of the basal and low-dose AVS respectively, whereas it was easy in all the cases of the standard-dose AVS.ConclusionsThe diagnosis in the basal AVS could be affected by the physiologic fluctuation of ACTH at relatively high prevalence. The basal AVS would be unreliable to differentiate two forms of PA.

scholarly journals An Alternative Method for Adrenal Venous Sampling in Cases in Which Right Adrenal Vein Sampling is Difficult

2022 ◽  
Author(s):  
Akira Yamamoto ◽  
Takeshi Fukunaga ◽  
Mitsuru Takeuchi ◽  
Hiroki Nakamura ◽  
Akihiko Kanki ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Inferior Vena ◽  
Vena Cava ◽  
Blood Sampling ◽  
Adrenal Vein ◽  
Threshold Values ◽  
Adrenal Vein Sampling ◽  
Alternative Method ◽  
Aldosterone Producing Adenoma ◽  
The Right

Abstract PurposeCatheterization of the right adrenal vein (rt.AdV) to obtain blood samples can often be difficult. The aim of the present study was to investigate whether blood sampling from the inferior vena cava (IVC) at its juncture with the rt.AdV can be an alternative to sampling of blood directly from the rt.AdV.Materials and MethodsThis study included 44 patients diagnosed with primary aldosteronism (PA) in whom AVS with adrenocorticotropic hormone (ACTH) was performed, resulting in a diagnosis of idiopathic hyperaldosteronism (IHA) (n=24), and patients diagnosed with unilateral aldosterone-producing adenoma (APA) (n=20; rt.APA=8, lt.APA=12). In addition to regular blood sampling, blood was also sampled from the IVC, as the substitute rt.AdV [S-rt.AdV]. Diagnostic performance with the conventional lateralized index (LI) and the modified LI using the S-rt.AdV was compared to examine the utility of the modified LI.ResultsThe modified LI of the rt.APA (0.4±0.4) was significantly lower than those of the IHA (1.4±0.7) (p<0.001) and the lt.APA (3.5±2.0) (p<0.001). The modified LI of the lt.APA was significantly higher than those of the IHA (p<0.001) and rt.APA (p<0.001). Sensitivity and specificity to diagnose rt.APA and lt.APA using the modified LI with threshold values of 0.7 and 2.2, respectively, they were 87% and 75%, respectively, and 94% and 94%, respectively.ConclusionThe modified LI has the potential to be an alternative method for rt.AdV sampling in cases in which rt.AdV sampling is difficult. Obtaining the modified LI is extremely simple, which might complement conventional AVS.

Utility of semi‐quantitative quick cortisol assay with low‐dose adrenocorticotropic hormone infusion adrenal vein sampling

2021 ◽  
Author(s):  
Matthew P. Sawyer ◽  
Eric X. Z. Yong ◽  
Benjamin Marginson ◽  
Stephen G. Farrell ◽  
Maresa M. Derbyshire ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Low Dose ◽  
Adrenal Vein ◽  
Adrenal Vein Sampling
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