Effect of Corticosteroid Premedication on Adrenal Vein Sampling in Patients with Primary Aldosteronism and Iodinated Contrast Allergy

Purpose: To evaluate the impact of corticosteroid premedication on the performance of adrenal vein sampling (AVS) in patients with primary aldosteronism (PA) and allergy to iodinated contrast media (ICM).

Materials and methods: Patients who underwent AVS for PA, between September 1990 and October 2023, were retrospectively identified. Patients with ICM allergy who received corticosteroid pre-medication were matched 1:1 with patients without contrast allergy. AVS was performed with continuous cosyntropin infusion (50 mcg/hour beginning 30 minutes before AVS). Patient demographics, clinical characteristics, AVS results, and follow-up data were compared.

Results: Of 1243 patients, 35 (2.8%) received corticosteroid premedication (methylprednisolone 32, dexamethasone 3), with no breakthrough contrast reactions. Three patients with coexisting PA and hypercortisolism were excluded. Clinical presentation did not differ between the two groups. Absolute median cortisol levels (mcg/dL) from both AV and the inferior vena cava (IVC) were similar between groups (right AV: 706 vs. 738, P=0.94; left AV: 475.5 vs. 406.5, P=0.15; IVC: 23 vs. 22, P=0.99). Bilaterally successful cannulation (selectivity index ≥5) rates were similar between groups (30 [93.8%] vs. 30 [93.8%], P=1). Identification of unilateral adrenal disease (lateralization index ≥4) was also similar (18 [56.3%] vs. 17 [53.1%], P>0.99). Surgery was performed in 14 cases and 15 controls, with similar rates of suppressed aldosterone on post-op day 1 (13 [92.9%] vs. 14 [93.3%], P >0.99) suggesting surgical cure.

Conclusion: AVS with continuous cosyntropin stimulation can be effectively performed in patients with ICM allergy and corticosteroid pre-medication with similar rates of disease subtyping and post-operative outcomes.