6.2 Comparison of Three Different Doses of ACTH Stimulation During Adrenal Vein Sampling (AVS) in the Work-Up of Primary
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High Blood Press Cardiovasc Prev 2008; 15 (3): 171-215 1120-9879/08/0003-0171/$48.00/0 © 2008 Adis Data Information BV. All rights reserved.
Hormonal Mechanisms 6.2 Comparison of Three Different Doses of ACTH Stimulation During Adrenal Vein Sampling (AVS) in the Work-Up of Primary Aldosteronism M. Seccia (1), D. Miotto (2), F. Mantero (3), G. Pitter (1), A. Patalano (3), A.C. Pessina (1), G. P. Rossi (1) ` di Padova, Padova; (2)Istituto di (1)DMCS, Clinica Medica 4, Universita ` di Padova, Padova; (3)Dipartimento di Scienze Mediche Radiologia, Universita ` di Padova, Padova, Italy e Chirurgiche, Universita Introduction. ACTH stimulation has been proposed to overcome the potential biases associated with pulsatile aldosterone secretion during Adrenal Vein Sampling (AVS). Different protocols and doses of synthetic ACTH have been used, but their performance was not systematically assessed thus far. Aim. To compare the effects of 3 different doses of ACTH on the selectivity (SI) and the lateralization index (LI). Methods. We prospectively tested the effects of a high dose (HD; 250 microg as an i.v. bolus, n=41), a very low dose (VLD, 250 picog as an i.v. bolus followed by 0.5 picog/min infusion, n= 6) and an intermediate dose (ID 50 microg/hr; n= 7) of synthetic ACTH (Synacthen, Novartis) on the SI and LI in patient referred for primary aldosteronism. Blood sampling for the measurement of plasma aldosterone (PAC) and cortisol (PCC) concentration were obtained at baseline and 30 minutes after ACTH stimulation, using bilaterally simultaneous AVS. The SI was calculated as the ratio of PCC in the right (CRAV) or left (CLAV) adrenal vein and the infrarenal inferior vena cava (CIVC); the LI was assessed as the ratio of PAC to PCC on the dominant (A/CSIDE) over the contralateral side (A/ CCTRL). The diagnosis of APA was based on pathology and follow-up data, according to the criteria of the PAPY Study. Results. The HD induced a highly significant increase of PCC in IVC (+83%, P
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