Significance of Cosyntropin Stimulation in Adrenal Vein Sampling

Presentation Number: SUN 512
Date of Presentation: April 2nd, 2017

Midori Sasaki Yatabe*1, Kanako Bokuda1, Junichi Yatabe1, Shihori Kimura1, Noriyoshi Takano1, Kaoru Yamashita1, Yasufumi Seki1, Michita Niiyama1, Daisuke Watanabe1, Satoru Morita1, Shuji Sakai2, Takashi Ando1, Satoshi Morimoto1 and Atsuhiro Ichihara1
1Tokyo Women's Medical University, Tokyo, Japan, 2Tokyo Women’s Medical University, Tokyo, Japan

Abstract

Cosyntropin stimulation has been performed during adrenal vein sampling (AVS) to determine the laterality of aldosterone oversecretion in primary aldosteronism. However, the significance of cosyntropin stimulation in AVS has not been fully established partly due to insufficient information on the association between the AVS data before or after cosyntropin stimulations and post-operative treatment outcome. Therefore, to assess the significance of cosyntropin stimulation in AVS, we investigated the differences in AVS indices before and after cosyntropin stimulations and determined whether post-cosyntropin AVS indices better correlate with treatment outcome than pre-cosyntropin AVS indices. The study was conducted as a retrospective study at a single institution, Tokyo Women’s Medical University Endocrine Center. A total of 185 patients who underwent AVS during 2013 to 2015 and had sufficient data for analysis were investigated. AVS data and treatment outcome of 81 cases who went through unilateral adrenalectomy from 2000 to 2015 for unilateral aldosterone oversecretion were also analyzed. Selectivity index (SI, adrenal cortisol/peripheral cortisol), lateralized ratio [LR, (dominant adrenal aldosterone/cortisol)/(non-dominant adrenal aldosterone/cortisol)], and contralateral ratio [CR, (non-dominant adrenal aldosterone/cortisol)/(peripheral aldosterone/cortisol)] before and after cosyntropin stimulations and blood pressure outcome 1 year after surgery were determined. The diagnosis of primary aldosteronism was based on 2 or more of 3 tests (captopril loading, furosemide upright, and saline loading) being positive. Cosyntropin stimulation was done by intravenous bolus injection of 0.25 mg of this agent, and post-cosyntropin AVS indices were mainly utilized to determine the indication of surgical treatment. The percentage of AVS cases with “successful catheterization” (defined as SI of ≥2 and SI of ≥5 before and after cosyntropin stimulations, respectively) increased after cosyntropin stimulation, 52% to 93% and 74% to 98% for the right and left adrenal veins, respectively. LR decreased after cosyntropin stimulations (from 12.9 ± 29.8 to 7.6 ± 24.2, P=0.05). Low CR (CR<1 vs. CR≥1, P<0.01) and high LR (LR2.6 vs. LR<2.6, P=0.047) after consyntropin stimulation better correlated with post-operative blood pressure outcome compared to those before cosyntropin stimulation (CR <1 vs. CR ≥1: P = 0.010, LR≥2 vs. LR<2: P = 0.010). All these data indicated that cosyntropin use in AVS facilitated the identification of successful catheterization, and post-cosyntropin AVS indices were more useful in predicting the treatment outcome after unilateral adrenalectomy, suggesting the significance of cosyntropin stimulation in AVS.

 

Nothing to Disclose: MSY, KB, JY, SK, NT, KY, YS, MN, DW, SM, SS, TA, SM, AI