Utility of semi‐quantitative quick cortisol assay with low‐dose adrenocorticotropic hormone infusion adrenal vein sampling

Sawyer, Matthew; Yong, Eric; Marginson, Benjamin; Farrell, Stephen; Derbyshire, Maresa M.; MacIsaac, Richard J; Sachithanandan, Nirupa

doi:10.1111/ans.17352

Cited by 5 publications

(1 citation statement)

References 22 publications

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“…These procedures make patients uncomfortable, and moving between the same facility’s radiology suite and laboratory room increases the financial burden. Our new POCT-QCA enables us to perform ICM rapidly in a simple process with low costs and high success rates 16 , 18 , 19 . As the ICM reported previously, studies have revealed that our QCA improves radiation exposure during AVS and the success rate of AVS 20 .…”

Section: Discussionmentioning

confidence: 99%

A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling

Aiga,

Kometani,

Karashima

et al. 2023

Sci Rep

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This study assessed the clinical performance of point-of-care testing (POCT) for quick cortisol assay (QCA) during adrenal vein sampling (AVS) using a newly invented portable quantitative assay instrument. An observational study was conducted prospectively at two centres in Japan. Forty-eight patients with primary aldosteronism considered for adrenalectomy were enrolled in this study and underwent AVS. Three basal adrenal vein samples from each adrenal vein and two from the inferior vena cava were collected sequentially. The cortisol concentration of adrenal vein samples was measured by routine method and QCA. A total of 338 adrenal vein samples were analysed from 250 sites to determine AVS success or failure. The distribution of turnaround time of the QCA for AVS success or failure followed a normal distribution with an average of 20.5 min. A positive correlation between the routine method and QCA was observed regarding cortisol concentration or selectivity index. No significant difference between the two methods was observed regarding the success rate of AVS. Using the routine method as a reference, the sensitivity and specificity of AVS success or failure were 99.1% (210/212) and 81.6% (31/38), respectively. Easy, quick, portable, and precise POCT-QCA demonstrated its compatibility with routine methods regarding clinical performance.

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Section: Discussionmentioning

confidence: 99%

A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling

Aiga,

Kometani,

Karashima

et al. 2023

Sci Rep

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Utility of Adrenal Vein Sampling With and Without Ultra‐Low Dose ACTH Infusion in the Diagnostic Evaluation of Primary Aldosteronism

Preston,

Yong,

Marginson

et al. 2024

Endocrino Diabet & Metabol

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BackgroundAdrenal 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.AimsTo assess if AVS performed with ultra‐low dose ACTH infusion causes discordant lateralisation.MethodsHere, 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).ResultsBilateral 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.DiscussionOverall, 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.ConclusionProspective 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.

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Key to the Treatment of Primary Aldosteronism in Secondary Hypertension: Subtype Diagnosis

Zuo,

Liu,

et al. 2023

Curr Hypertens Rep

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Utility of semi‐quantitative quick cortisol assay with low‐dose adrenocorticotropic hormone infusion adrenal vein sampling

Abstract: The corresponding author is not a recipient of a research scholarship.The paper is not based on a previous communication to a society or meeting.

Cited by 5 publications

References 22 publications

A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling

A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling

Utility of Adrenal Vein Sampling With and Without Ultra‐Low Dose ACTH Infusion in the Diagnostic Evaluation of Primary Aldosteronism

Key to the Treatment of Primary Aldosteronism in Secondary Hypertension: Subtype Diagnosis

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