Journal of vascular and interventional radiology : JVIR · 2024
Effect of Corticosteroid Premedication on Adrenal Vein Sampling in Patients with Primary Aldosteronism and Iodinated Contrast Media Allergy.
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Mohan Sneha, Shariq Omair A, Andrews James C, Young William F
Аннотация
PURPOSE: To evaluate the impact of corticosteroid premedication on the performance of adrenal vein sampling (AVS) in patients with primary aldosteronism (PA) and allergy to iodinated contrast media (ICM).
MATERIALS AND METHODS: Patients who underwent AVS for PA between September 1990 and October 2023, were retrospectively identified. Patients with ICM allergy who received corticosteroid premedication were matched 1:1 with patients without contrast media allergy. AVS was performed with continuous cosyntropin infusion (50 μg/h beginning 30 minutes before AVS). Patient demographics, clinical characteristics, AVS results, and follow-up data were compared.
RESULTS: Of 1,243 patients, 35 (2.8%) received corticosteroid premedication (methylprednisolone, 32; dexamethasone, 3), with no breakthrough contrast media allergy reactions. Three patients with coexisting PA and hypercortisolism were excluded. Clinical presentation did not differ between the 2 groups. The absolute median cortisol levels (μg/dL) from both the adrenal vein (AV) and inferior vena cava (IVC) were similar between groups (right AV, 706 vs 738 [P = .94]; left AV, 475.5 vs 406.5 [P = .15]; IVC, 23 vs 22 [P = .99]). Bilaterally successful cannulation (selectivity index, ≥5) rates were similar between groups (30 [93.8%] vs 30 [93.8%], P = 1). Identification of unilateral adrenal disease (lateralization index, ≥4) was also similar (18 [56.3%] vs 17 [53.1%], P > .99). Surgery was performed in 14 cases and 15 controls, with similar rates of suppressed aldosterone on postoperative Day 1 (13 [92.9%] vs 14 [93.3%], P > .99) suggesting surgical cure.
CONCLUSIONS: AVS with continuous cosyntropin stimulation can be effectively performed in patients with ICM allergy and corticosteroid premedication with similar rates of disease subtyping and postoperative outcomes.
MATERIALS AND METHODS: Patients who underwent AVS for PA between September 1990 and October 2023, were retrospectively identified. Patients with ICM allergy who received corticosteroid premedication were matched 1:1 with patients without contrast media allergy. AVS was performed with continuous cosyntropin infusion (50 μg/h beginning 30 minutes before AVS). Patient demographics, clinical characteristics, AVS results, and follow-up data were compared.
RESULTS: Of 1,243 patients, 35 (2.8%) received corticosteroid premedication (methylprednisolone, 32; dexamethasone, 3), with no breakthrough contrast media allergy reactions. Three patients with coexisting PA and hypercortisolism were excluded. Clinical presentation did not differ between the 2 groups. The absolute median cortisol levels (μg/dL) from both the adrenal vein (AV) and inferior vena cava (IVC) were similar between groups (right AV, 706 vs 738 [P = .94]; left AV, 475.5 vs 406.5 [P = .15]; IVC, 23 vs 22 [P = .99]). Bilaterally successful cannulation (selectivity index, ≥5) rates were similar between groups (30 [93.8%] vs 30 [93.8%], P = 1). Identification of unilateral adrenal disease (lateralization index, ≥4) was also similar (18 [56.3%] vs 17 [53.1%], P > .99). Surgery was performed in 14 cases and 15 controls, with similar rates of suppressed aldosterone on postoperative Day 1 (13 [92.9%] vs 14 [93.3%], P > .99) suggesting surgical cure.
CONCLUSIONS: AVS with continuous cosyntropin stimulation can be effectively performed in patients with ICM allergy and corticosteroid premedication with similar rates of disease subtyping and postoperative outcomes.