菜单
Recommends ACTH stimulation during AVS to improve success rate of bilateral selective catheterization, acknowledging unclear impact on diagnostic accuracy for laterality. Triggers include when setting up AVS and asking 'Should I administer ACTH?' or considering procedural optimization.
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| name | jes-pa-avs-acth-stimulation |
| description | Recommends ACTH stimulation during AVS to improve success rate of bilateral selective catheterization, acknowledging unclear impact on diagnostic accuracy for laterality. Triggers include when setting up AVS and asking 'Should I administer ACTH?' or considering procedural optimization. |
Collect patient eligibility for AVS (positive confirmatory test for PA, surgical intent), availability of synthetic ACTH (Cosyntropin), planned AVS protocol (IV bolus vs infusion), timing of blood sampling relative to ACTH, and institutional AVS expertise; then determine if AVS is indicated.
Is adrenal venous sampling (AVS) indicated for subtype diagnosis in primary aldosteronism? If no, do not proceed with ACTH stimulation. If yes, proceed to evaluate ACTH use.
Classify the goal: If aiming to improve success rate of bilateral selective catheterization during AVS, proceed to recommend ACTH stimulation; if focusing solely on diagnostic accuracy for laterality, note ACTH stimulation’s unclear impact.
Recommend administering ACTH stimulation during AVS to increase the selectivity index and achieve successful bilateral selective catheterization.
ACTH stimulation does not reliably improve diagnostic accuracy for laterality; ensure ACTH‑sampling interval of 15–30 min; avoid use in rare ACTH hypersensitivity; do not substitute ACTH for proper catheter technique or center expertise; consider institutional protocols for ACTH dosing (IV bolus 250 μg or infusion 50–80 μg/h).
A 48‑year‑man with PA undergoes AVS at an experienced center; after 250 μg IV ACTH bolus, bilateral selective catheterization achieved (SI ≥ 5), enabling subtype diagnosis and guiding adrenalectomy.
Source: Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021, Japan Endocrine Society, 2021