Adrenal Vein Sampling in a Patient With Primary Hyperaldosteronism and Severe Contrast Allergy

We report on a case of a 50-year-old female patient with primary hyperaldosteronism, in whom adrenal venous sampling was required to differentiate between unilateral and bilateral disease. Because of a history of severe allergy to iodinated contrast media, premedication with glucocorticoids was indicated. Exogenous glucocorticoids, however, can affect measurements of serum cortisol. To avoid this potential confounding effects on the cortisol assay, we decided to use dexamethasone instead of prednisolone or hydrocortisone. A high-dose adrenocorticotropin (ACTH) stimulation test with the simultaneous use of dexamethasone revealed an adequate adrenal cortisol response. ACTH-stimulated adrenal venous sampling showed reliable results, which provided a solid basis for further clinical decision-making.

Automated summary

This case report discusses a 50-year-old female patient with primary hyperaldosteronism who underwent adrenal venous sampling to differentiate between unilateral and bilateral disease. Premedication with glucocorticoids, specifically dexamethasone, was used to avoid potential confounding effects on cortisol measurements. High-dose ACTH stimulation test with dexamethasone and ACTH-stimulated adrenal venous sampling revealed reliable results for further clinical decision-making.