"Successful" adrenal vein catheterization in primary
aldosteronism (PA) is often defined by a ratio of >3:1 of
cortisol in the adrenal vein vs the inferior vena cava. Non-use of
corticotropin (
ACTH) during sampling may increase the apparent failure rate of adrenal vein catheterization due to lower
cortisol levels. A retrospective study was performed on all patients with confirmed unilateral PA between June 2005 and August 2011. Adrenal vein sampling (AVS) included simultaneous bilateral baseline samples with repeat sampling 15 minutes after
intravenous infusion of 250 μg of
Cortrosyn (
ACTH-S). Successful
catheter placement was judged as adrenal
cortisol:IVC
cortisol of >3:1, applied to both baseline and
ACTH-S samples and lateralization of
aldosteronism was judged as normalized
aldosterone/
cortisol (A/C) ratio >3 times the contralateral A/C ratio. In
ACTH-S samples, 94% of right-sided catheterizations were biochemically successful with 100% success on the left. Among baseline samples, only 47% of right- and 44% of left-sided samples met the 3:1
cortisol criteria. However, 95% of apparent "failed" baseline
cortisol sets still showed lateralization of A/C ratios that matched the ultimate pathology. Non-
ACTH-stimulated samples may be incorrectly judged as failed
catheter placement when a 3:1 ratio is used.
ACTH-stimulated sampling is the preferred means to confirm catheterization during AVS.