AVS w/ACTH?

[Guest guest]

Dr. Grim, you always recommend ACTH with AVS. I came across this study and

wonder if that is an older protocol. This at the minimum makes me think it

might depend on local experience. (Or if you desire to find ALL surgically

correctable cases!) Comments?

" Conclusions

A high and an intermediate ACTH dose stimulated cortisol secretion from the

adrenal with APA and from the contralateral one, thus improving the

ascertainment of the selectivity of adrenal vein catheterization during AVS. By

contrast, the lowest previously proposed dose5,7 had no appreciable effect on

cortisol secretion and, therefore, was not helpful for confirming the

selectivity of AVS. The improvement in the ascertainment of selectivity

occurring with both the high and the intermediate ACTH doses was overridden by

the confounding effect on identification of lateralized aldosterone excess.

Therefore, we do not recommend using systematic ACTH stimulation. "

Source: http://hyper.ahajournals.org/content/53/5/761.full

Adrenocorticotropic Hormone Stimulation During Adrenal Vein Sampling for

Identifying Surgically Curable Subtypes of Primary Aldosteronism

Comparison of 3 Different Protocols

M. Seccia,

Diego Miotto,

Renzo De Toni,

Gisella Pitter,

Franco Mantero,

Achille C. Pessina,

Gian Paolo Rossi

+ Author Affiliations

From the Department of Clinical and Experimental Medicine-Internal Medicine 4

(T.M.S., R.D.T., G.P., A.C.P., G.P.R.), Institute of Radiology (D.M.), and

Department of Medical and Surgical Sciences (F.M.), University of Padua School

of Medicine, Padua, Italy.

Correspondence to Gian Paolo Rossi, DMCS-Clinica Medica 4, University Hospital,

via Giustiniani 2, 35128 Padova, Italy. E-mail gianpaolo.rossi@...

- 65 yo super ob. male - 12mm X 13mm rt. a.adnoma with previous rt. flank

pain. Treating with DASH. 2-Day ave w/o meds = BP 133/77 HR 61 BS 132. D/C

Spironolactone 12/20/2011 due to adverse SX.

Other Issues/Opportunities: OSA w Bi-Pap settings 13/19, DM2, Gynecomastia, MDD

and PTSD.

Meds: Duloxetine hcl 80 MG, Metoprolol Tartrate 200 MG, 81mg aspirin and

Metformin 2000MG. Started washing Spironolactone 12/20/11 to prepare for AVS.