Department of Physiology, Georgia Health Sciences University, Augusta, GA, USA.
Hypertension. 2012 Apr;59(4):840-6. doi: 10.1161/HYPERTENSIONAHA.111.189548. Epub 2012 Feb 13.
Adrenal vein sampling (AVS) is fundamental for subtype diagnosis in patients with primary aldosteronism. AVS protocols vary between centers, especially for diagnostic indices and for use of adrenocorticotropic hormone (ACTH) stimulation. We investigated the role of both continuous ACTH infusion and bolus on the performance and interpretation of AVS in a sample of 76 patients with confirmed primary aldosteronism. In 36 primary aldosteronism patients, AVS was performed both under basal conditions and after continuous ACTH infusion, and in 40 primary aldosteronism patients, AVS was performed both under basal conditions and after ACTH IV bolus. Both ACTH protocols determined an increase in the rate of successful cannulation of the adrenal veins. Both ACTH infusion and bolus determined a significant increase in selectivity index for the right adrenal vein and ACTH bolus for the left adrenal vein. Lateralization index was not significantly different after continuous ACTH infusion and IV bolus. In 88% and 78% of the patients, the diagnosis obtained was the same before and after ACTH infusion and IV bolus, respectively. However, the reproducibility of the diagnosis was reduced using less stringent criteria for successful cannulation of the adrenal veins. This study shows that ACTH use during AVS may be of help for centers with lower success rates, because a successful adrenal cannulation is more easily obtained with this protocol; moreover, this technique performs at least as well as the unstimulated strategy and in some cases may be even better. Stringent criteria for cannulation should be used to have a high consistency of the diagnosis.
肾上腺静脉采样（AVS）对于原发性醛固酮增多症患者的亚型诊断至关重要。各中心的 AVS 方案存在差异，尤其是在诊断指标和促肾上腺皮质激素（ACTH）刺激的使用方面。我们研究了连续 ACTH 输注和 ACTH 静脉推注这两种方法在 76 例确诊原发性醛固酮增多症患者样本中对 AVS 性能和解读的作用。在 36 例原发性醛固酮增多症患者中，我们在基础状态和连续 ACTH 输注后进行了 AVS，在 40 例原发性醛固酮增多症患者中，我们在基础状态和 ACTH 静脉推注后进行了 AVS。两种 ACTH 方案均提高了肾上腺静脉成功插管率。两种 ACTH 方案均显著提高了右侧肾上腺静脉的选择性指数，ACTH 静脉推注提高了左侧肾上腺静脉的选择性指数。连续 ACTH 输注和静脉推注后，侧化指数无显著差异。在 88%和 78%的患者中，分别在 ACTH 输注和静脉推注前后获得了相同的诊断。然而，使用更宽松的肾上腺静脉插管成功标准，诊断的可重复性降低。这项研究表明，在 AVS 期间使用 ACTH 可能对成功率较低的中心有帮助，因为该方案更容易获得成功的肾上腺插管；此外，该技术的性能至少与未刺激策略相当，在某些情况下可能更好。应使用严格的插管标准，以获得诊断的高度一致性。
