How does contralateral suppression of more than 50% with cosyntropin during adrenal venous sampling influence your decision to recommend adrenalectomy in patients with primary aldosteronism?  

Most but not all studies support it as a secondary criterion, and ratios <1 and 0.5 compared to the periphery have been suggested. There have been rare cases where I have used it as the sole criterion where the contralateral adrenal vein could not be successfully catheterized (usually in conjunct...