Adrenal vein sampling with continuous infusion of cosyntropin for identifying surgically curable cases of primary aldosteronism.

PURPOSE: Cosyntropin (ACTH) bolus stimulation prior to adrenal vein sampling (AVS) increases sampling selectivity but reduces sensitivity for lateralization, predictive of surgical cure. We examined effectiveness of an alternative continuous cosyntropin stimulation, without bolus, specifically via rates of sampling adequacy, lateralization, and surgical cure among patients with primary hyperaldosteronism.

MATERIALS AND

METHODS

A single institution retrospective review was performed of a cohort of consecutive patients with primary aldosteronism who underwent AVS from 2014 to 2021 with cosyntropin infusion of 50 μg/h without bolus. Primary procedure-related outcomes include sampling adequacy and lateralization. Clinical outcomes include progression to adrenalectomy, surgical pathology, postoperative decrease in antihypertensive medication requirement and/or discontinuation of potassium-sparing diuretics with resolution of hypokalemia.

RESULTS

Of 88 patients undergoing AVS with non-bolus ACTH stimulation (55 male, 33 female; mean age 53 years), sampling selectivity was adequate in 78 (89 %). Unilateral hypersecretion was identified in 48 (62 %) patients and 45 of them (94 %) progressed to adrenalectomy. Clinical response was achieved in 42/43 (98 %) patients at the time of routine 1-3 month postoperative follow-up clinic visit.

CONCLUSION

Continuous ACTH infusion was associated with high rates of AVS sampling selectivity as well as lateralization and was highly predictive of post-adrenalectomy clinical response. As such, it may be superior to traditional bolus-based stimulation.