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(Hypertension. 2009;53:761.)
© 2009 American Heart Association, Inc.

Original Articles

Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling for Identifying Surgically Curable Subtypes of Primary Aldosteronism

Comparison of 3 Different Protocols

Teresa M. Seccia; Diego Miotto; Renzo De Toni; Gisella Pitter; Franco Mantero; Achille C. Pessina; Gian Paolo Rossi

From the Department of Clinical and Experimental Medicine-Internal Medicine 4 (T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and Department of Medical and Surgical Sciences (F.M.), University of Padua School of Medicine, Padua, Italy.

Correspondence to Gian Paolo Rossi, DMCS-Clinica Medica 4, University Hospital, via Giustiniani 2, 35128 Padova, Italy. E-mail gianpaolo.rossi{at}unipd.it

Adrenocorticotropic hormone administration was proposed to overcome the biases associated with pulsatile aldosterone secretion during adrenal venous sampling, but the usefulness of different protocols of stimulation was never systematically assessed. We, therefore, compared the effects of a high dose (HD; 250 µg IV as a bolus), a very low dose (VLD; 250 pg IV), and an intermediate dose (ID; 50 µg/h) of adrenocorticotropic hormone on the selectivity index (SI) and the lateralization index in primary aldosteronism patients, using the diagnosis of aldosterone-producing adenoma, based on pathology and follow-up data, as a reference. The HD (n=47) significantly increased plasma cortisol concentration in infrarenal inferior vena cava (+79%) blood and the SI on both sides (SI_RIGHT+113% and SI_LEFT+131%), as compared with baseline values. The ID (n=14) also markedly increased both plasma cortisol concentration inferior vena cava (+93%) and the SI (SI_RIGHT+690% and SI_LEFT+410%); the very low dose (n=6) had no effect on either the plasma cortisol concentration or SI. In the patients with unilateral aldosterone-producing adenoma, the increase of selectivity with the HD and ID was counterbalanced by a confounding effect on the correct identification of the aldosterone-producing adenoma side, which was attributed to the wrong side in 3.0% and 12.5% with HD and ID, respectively. In conclusion, the HD and the ID, but not the very low dose, adrenocorticotropic hormone stimulation protocol facilitated the ascertainment of selectivity of adrenal vein catheterization. However, this favorable effect was overridden by a confounding effect on the identification of lateralized aldosterone excess to the aldosterone-producing adenoma side. Hence, we do not recommend adrenocorticotropic hormone stimulation.

Key Words: aldosteronism • adrenal venous sampling • adenoma • ACTH • cortisol

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