Abstract 90: Long-acting porcine sequence corticotrophin stimulated adrenal vein sampling for subtyping primary hyperaldosteronism

Background: Adrenal vein sampling (AVS) is the recommended standard test to distinguish between unilateral and bilateral disease in patients with primary hyperaldosteronism. Use of co syntropin stimulation during AVS has been advocated. However, co syntropin is not widely available in India. Synthetic porcine sequence corticotrophin is freely available as Acton Prolongatum. Here we report 2 cases, where Acton Prolongatum stimulated AVS was used for subtyping primary aldosteronism. Methods: Two patients with hypertension and hypokalemia were detected to have hyperaldosteronism. Their clinical and laboratory parameters are shown in [Table 1]. AVS was done to subtype the disease. Two doses of Inj. Acton Prolongatum, 0.5 ml, were given, intra muscularly, 1 hour apart (2nd dose given 30 minutes before procedure). Peripheral blood samples for ACTH were taken 1 hour and 2 hours afterthe 2nd injection. The right and left adrenal veins were sequentially cannulated, via the right femoral vein and samples were collected from each side and from the right femoral vein. The samples were assayed for aldosterone and cortisol.{Table 1} Results: The results of AVS are shown in [Table 2]. The peripheral blood samples collected after intra muscular injection of Acton Prolongatum showed high levels of ACTH (at 1 hour and 2 hour) suggesting adequate stimulation. The first patient had no lateralisation and the second patient had lateralisation to the right side. Accordingly, the first patient was managed with spironolactone and the second patient underwent robotic right adrenalectomy.{Table 2} Conclusion: In instances where Co syntropin is not available for AVS, Acton prolongatum may be successfully used as an alternative.