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Intraprocedural Cortisol Measurement Increases Adrenal Vein Sampling Success Rate in Primary Aldosteronism.
MedLine Citation:
PMID:  21850058     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BackgroundAdrenal venous sampling (AVS) is the gold standard for the identification of unilateral primary aldosteronism (PA), but is technically difficult. The aim of our study was to assess whether intraprocedural cortisol measurement (IPCM) increases AVS success rate.MethodsTwenty-five consecutive PA patients underwent cosyntropin-stimulated AVS. Cortisol was measured immediately in a first set of samples drawn from adrenal veins and inferior vena cava. The selectivity criterion was an adrenal vein-to-inferior vena cava cortisol ratio ≥5. If bilateral selectivity was not achieved in a first set of samples, a second set was obtained during the same radiological session. PA was judged as unilateral if the gradient of cortisol-corrected aldosterone between dominant and nondominant side was >3.5. Twenty-five consecutive PA patients who had previously been submitted to AVS without IPCM served as historical controls. Lateralizing patients who underwent unilateral adrenalectomy were followed for 2 years after surgery.ResultsBilateral selectivity using IPCM was achieved in 19/25 patients in the first set of samples, and in an additional four cases in the second set (92% vs. 76%; P = 0.06). The final rate of bilateral selectivity was higher than that obtained in the historical series (23/25 vs. 16/25, P = 0.04), whereas bilateral selectivity in the first set of samples was not different from that achieved in the historical series. Nineteen lateralizing patients (13 of the present series, six of the historical series) were submitted to adrenalectomy, resulting in reversal of PA.ConclusionsIPCM increases the success rate of AVS.American Journal of Hypertension (2011). doi:10.1038/ajh.2011.148.
Authors:
Ermanno Rossi; Giuseppe Regolisti; Franco Perazzoli; Aurelio Negro; Chiara Grasselli; Rosaria Santi; Simonetta Cavalieri; Lucia Belloni; Giuseppe Gemelli; Edoardo Della Valle; Diego Miotto
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-18
Journal Detail:
Title:  American journal of hypertension     Volume:  -     ISSN:  1941-7225     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8803676     Medline TA:  Am J Hypertens     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Second Unit of Internal Medicine, Department of Internal Medicine, Santa Maria Nuova Hospital, Reggio Emilia, Italy.
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