Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Department of Medicine, The University of Melbourne, St Albans, Victoria, Australia.
Endocrinol Diabetes Metab. 2024 Sep;7(5):e70001. doi: 10.1002/edm2.70001.
Adrenal vein sampling (AVS), integral to identifying surgically remediable unilateral primary aldosteronism (PA), is technically challenging and subject to fluctuations in cortisol and aldosterone secretion. Intra-procedural adrenocorticotropic hormone (ACTH), conventionally administered as a 250-μg bolus and/or 50 μg per hour infusion, increases cortisol and aldosterone secretion and can improve AVS success, but may cause discordant lateralisation compared to unstimulated AVS.
To assess if AVS performed with ultra-low dose ACTH infusion causes discordant lateralisation.
Here, we describe our preliminary experience using an ultra-low dose ACTH infusion AVS protocol. We retrospectively reviewed the results of consecutive AVS procedures (n = 37) performed with and without ultra-low dose ACTH (1-μg bolus followed by 1.25 μg per hour infusion).
Bilateral AV cannulation was successful in 70% of procedures pre-ACTH and 89% post-ACTH (p < 0.01). Sixty-nine percent of studies lateralised pre-ACTH and 55% post-ACTH, improving to 79% when both groups were combined. Lateralisation was discordant in 11 cases, including eight in which lateralisation was present only on basal sampling, and three in which lateralisation occurred only with ACTH stimulation.
Overall, the decrease in lateralisation rates with ACTH was higher than previously reported for some protocols utilising conventional doses of ACTH. Our results suggest that AVS performed with ultra-low dose ACTH can cause discordant lateralisation similar to AVS performed with conventional doses of ACTH.
Prospective studies directly comparing low and conventional dose ACTH AVS protocols and long-term patient outcomes are needed to help define the optimal ACTH dose for accurate PA subtyping.
肾上腺静脉采样（AVS）是确定可通过手术治疗的单侧原发性醛固酮增多症（PA）的关键手段，但技术要求高，且易受到皮质醇和醛固酮分泌波动的影响。术中给予促肾上腺皮质激素（ACTH），通常给予 250μg 冲击量和/或 50μg/小时输注，可以增加皮质醇和醛固酮的分泌，提高 AVS 的成功率，但与未刺激的 AVS 相比，可能导致侧化不一致。
评估使用超低剂量 ACTH 输注进行 AVS 是否会导致侧化不一致。
我们在此描述了使用超低剂量 ACTH 输注 AVS 方案的初步经验。我们回顾性分析了连续进行的 AVS 程序（n=37）的结果，这些程序分别在使用和不使用超低剂量 ACTH（1μg 冲击量后 1.25μg/小时输注）的情况下进行。
ACTH 前，双侧 AV 插管成功率为 70%，ACTH 后为 89%（p<0.01）。ACTH 前 69%的研究显示侧化，ACTH 后 55%显示侧化，两组合并后提高至 79%。11 例出现侧化不一致，其中 8 例仅在基础采样时出现侧化，3 例仅在 ACTH 刺激时出现侧化。
总的来说，与某些使用常规剂量 ACTH 的方案相比，ACTH 后侧化率的下降更高。我们的结果表明，与使用常规剂量 ACTH 的 AVS 相比，使用超低剂量 ACTH 进行的 AVS 可能会导致侧化不一致。
需要进行前瞻性研究，直接比较低剂量和常规剂量 ACTH AVS 方案以及长期患者结局，以帮助确定用于准确 PA 亚型分类的最佳 ACTH 剂量。
