Seccia Teresa M, Miotto Diego, De Toni Renzo, Pitter Gisella, Mantero Franco, Pessina Achille C, Rossi Gian Paolo
Department of Clinical and Experimental Medicine-Internal Medicine 4, University of Padua School of Medicine, Padua, Italy.
Hypertension. 2009 May;53(5):761-6. doi: 10.1161/HYPERTENSIONAHA.108.128553. Epub 2009 Apr 6.
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 microg IV as a bolus), a very low dose (VLD; 250 pg IV), and an intermediate dose (ID; 50 microg/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.
有人提出给予促肾上腺皮质激素以克服肾上腺静脉采血期间与醛固酮脉冲式分泌相关的偏差，但不同刺激方案的有效性从未得到系统评估。因此，我们比较了高剂量（HD；静脉推注250微克）、极低剂量（VLD；静脉注射250皮克）和中等剂量（ID；50微克/小时）促肾上腺皮质激素对原发性醛固酮增多症患者选择性指数（SI）和侧化指数的影响，以基于病理和随访数据诊断醛固酮瘤作为参考。与基线值相比，HD组（n = 47）显著提高了肾下下腔静脉血中血浆皮质醇浓度（+79%）以及两侧的SI（右侧SI +113%，左侧SI +131%）。ID组（n = 14）也显著提高了下腔静脉血浆皮质醇浓度（+93%）和SI（右侧SI +690%，左侧SI +410%）；极低剂量组（n = 6）对血浆皮质醇浓度或SI均无影响。在单侧醛固酮瘤患者中，HD组和ID组选择性增加，但对醛固酮瘤侧的正确识别存在混杂效应，HD组和ID组分别有3.0%和12.5%的病例将醛固酮瘤定错侧。总之，HD组和ID组促肾上腺皮质激素刺激方案有助于确定肾上腺静脉插管的选择性。然而，这种有利影响被对醛固酮瘤侧侧化醛固酮增多症识别的混杂效应所抵消。因此，我们不推荐使用促肾上腺皮质激素刺激。
