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

Autor: Sawyer MP; Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia., Yong EXZ; Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia., Marginson B; Department of Radiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia., Farrell SG; Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia., Derbyshire MM; Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia., MacIsaac RJ; Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.; Department of Medicine, The University of Melbourne, Fitzroy, Victoria, Australia., Sachithanandan N; Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.; Department of Medicine, The University of Melbourne, Fitzroy, Victoria, Australia.
Jazyk: angličtina
Zdroj: ANZ journal of surgery [ANZ J Surg] 2022 Mar; Vol. 92 (3), pp. 437-442. Date of Electronic Publication: 2021 Nov 21.
DOI: 10.1111/ans.17352
Abstrakt: Background: Adrenal vein sampling (AVS) is integral to identifying surgically remediable unilateral primary aldosteronism (PA). However, right adrenal vein (AV) cannulation can be challenging, limiting its success. Intra-procedural cortisol assays can improve the reliability of AVS. The aim of this study was to validate the use of semi-quantitative cortisol estimates obtained utilizing a quick cortisol assay (QCA) during AVS procedures at our institution.
Methods: Retrospective review of results of AVS procedures before and after the introduction of the QCA. Twenty-three AVS procedures were performed with the provisional success determined by intra-procedural QCA. Successful AV cannulation was defined by an AV to peripheral vein cortisol ratio ≥ 4.0 (the selectivity index) from laboratory measurements. The control cohort consisted of 23 consecutive procedures prior to introduction of the QCA.
Results: QCA correctly predicted all AV cannulation attempts. Successful bilateral AV cannulation increased from 52% to 91% of procedures when performed with the QCA (P = 0.01) and adequate cannulation of the right AV increased from 61% to 91% (P = 0.03). There was no increase in procedural time, number of AV cannulation or sampling attempts.
Conclusions: Point-of-care, semi-quantitative cortisol estimates can be performed accurately during AVS with QCA, facilitating improvements in AVS success rates without increasing procedural time.
(© 2021 Royal Australasian College of Surgeons.)
Databáze: MEDLINE
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