Preparation of patients with iodine contrast media (ICM) allergy who require adrenal vein sampling (AVS) to establish source of aldosterone excess of their confirmed primary aldosteronism (PA) is controversial. Usual premedication with high dose prednisone can interfere with cortisol determinations, possibly altering the aldosterone-to-cortisol ratios for the identification of lateralized aldosterone excess. The objective of the study was to evaluate the efficacy and safety of premedication with high dose dexamethasone to perform AVS in patients with ICM. 177 consecutive patients with confirmed PA who underwent bilateral simultaneous basal and post ACTH bolus AVS at our center between January 2010 and December 2020 were retrospectively analyzed for history of ICM allergy. A total of 7 patients (4%) with previous allergic reactions to ICM were prepared with three doses of 7.5 mg dexamethasone premedication rather than the usual 50 mg of prednisone. No breakthrough allergic reactions were reported in the 7 patients. Despite adequate serum cortisol suppression following dexamethasone, the basal and post-ACTH selectivity index (SI) were respectively >2 and > 5 bilaterally in all patients, confirming adequate cannulation of both adrenal veins. Four patients had lateralized ratios (A/C ratio > 2 basally and >4 post ACTH), while three had bilateral source during AVS study. In the three patients undergoing unilateral adrenalectomy for lateralized source and contralateral suppression and adequate follow-up data, cure of PA was achieved at mean 58 months post-operatively. AVS using dexamethasone premedication is safe and accurate for diagnosing source of aldosterone excess in patients with PA and ICM allergy.
Authors: Nada Younes, Eric Therasse, Isabelle Bourdeau, André Lacroix
Keywords: adrenal venous sampling, AVS, dexamethasone, iodine contrast media allergy, ICM
DOI Number: 10.1210/jendso/bvac093 Publication Year: 2022
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