Effect of Corticosteroid Premedication on Adrenal Vein Sampling in Patients with Primary Aldosteronism and Iodinated Contrast Media Allergy.

PURPOSE

To evaluate the impact of corticosteroid premedication on the performance of adrenal vein sampling (AVS) in patients with primary aldosteronism (PA) and allergy to iodinated contrast media (ICM).

MATERIALS AND METHODS

Patients who underwent AVS for PA between September 1990 and October 2023, were retrospectively identified. Patients with ICM allergy who received corticosteroid premedication were matched 1:1 with patients without contrast media allergy. AVS was performed with continuous cosyntropin infusion (50 μg/h beginning 30 minutes before AVS). Patient demographics, clinical characteristics, AVS results, and follow-up data were compared.

RESULTS

Of 1,243 patients, 35 (2.8%) received corticosteroid premedication (methylprednisolone, 32; dexamethasone, 3), with no breakthrough contrast media allergy reactions. Three patients with coexisting PA and hypercortisolism were excluded. Clinical presentation did not differ between the 2 groups. The absolute median cortisol levels (μg/dL) from both the adrenal vein (AV) and inferior vena cava (IVC) were similar between groups (right AV, 706 vs 738 [P = .94]; left AV, 475.5 vs 406.5 [P = .15]; IVC, 23 vs 22 [P = .99]). Bilaterally successful cannulation (selectivity index, ≥5) rates were similar between groups (30 [93.8%] vs 30 [93.8%], P = 1). Identification of unilateral adrenal disease (lateralization index, ≥4) was also similar (18 [56.3%] vs 17 [53.1%], P > .99). Surgery was performed in 14 cases and 15 controls, with similar rates of suppressed aldosterone on postoperative Day 1 (13 [92.9%] vs 14 [93.3%], P > .99) suggesting surgical cure.

CONCLUSIONS

AVS with continuous cosyntropin stimulation can be effectively performed in patients with ICM allergy and corticosteroid premedication with similar rates of disease subtyping and postoperative outcomes.