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Impact of adrenocorticotropic hormone stimulation during adrenal venous sampling on outcomes of primary aldosteronism

Takeda, Yoshiyua; Umakoshi, Hironobub; Takeda, Yoshimichia; Yoneda, Takashia; Kurihara, Isaoc; Katabami, Takuyukid; Ichijo, Takamasae; Wada, Noriof; Yoshimoto, Takanobug; Ogawa, Yoshihirog; Kawashima, Junjih; Sone, Masakatsui; Takahashi, Katsutoshij; Watanabe, Minemorik; Matsuda, Yuichil; Kobayashi, Hirokim; Shibata, Hirotakan; Kamemura, Koheio; Otsuki, Michiop; Fujii, Yuichiq; Yamamto, Koichir; Ogo, Atsushis; Yanase, Toshihikot; Suzuki, Tomokou; Naruse, Mitsuhideb JPAS Study Group

doi: 10.1097/HJH.0000000000001964
ORIGINAL PAPERS: Secondary hypertension

Background: Adrenal venous sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism. Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve the success rate of AVS, although the effects on lateralization and its outcomes in unilateral primary aldosteronism are unclear.

Methods: The success rate and lateralization indices were examined in a cohort of 2197 Japanese patients with primary aldosteronism from 28 centres who underwent AVS. Outcomes were analysed in 267 patients with aldosterone-producing adenomas (APAs).

Results: ACTH loading during AVS improved the success rate from 67 to 89%, while lateralization indices decreased from 62 to 28%. Bolus, bolus along with continuous infusion or continuous infusion of ACTH did not affect both indices. The absence of clinical success (i.e. unchanged or increased blood pressure) was 33% and absence of biochemical success (persistent hypokalaemia or persistently raised aldosterone-to-renin ratio, or both) was 15%. The clinical and biochemical success rates did not differ between the three groups [lateralization index >2 in basal condition (LIb) and lateralization index >4 after ACTH loading (lateralization indices), and LIb >2 + lateralization indices<4, LIb<2+lateralization indices>4]. The three groups (LIb>4+lateralization indices>4, LIb>4+lateralization indices<4 and LIb<4+lateralization indices>4) did not show any significant differences of clinical and biochemical outcome.

Conclusion: ACTH loading during AVS improved the success rate but decreased laterality. ACTH did not affect the clinical and biochemical outcomes in APA patients. These data showed that the use of ACTH during AVS was helpful for improving the success rate, but did not contribute to better outcomes.

aDepartment of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa

bDepartment of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto

cDepartment of Endocrinology, Metabolism and Nephrology, School of Medicine Keio University, Tokyo

dDivision of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital

eDepartment of Endocrinology and Metabolism, Saiseikai, Yokohamashi Tobu Hospital, Yokohama

fDepartment of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo

gDepartment of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo

hDepartment of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto University, Kumamoto

iDepartment of Diabetes, Endocrinology and Nutrition Kyoto University, Kyoto

jDivision of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo

kDepartment of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki

lDepartment of Cardiology, Sanda City Hospital, Sanda

mDivision of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo

nDepartment of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu

oDepartment of Cardiology, Akashi Medical Center, Akashi

pDepartment of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka

qDepartment of Cardiology, JR Hiroshima Hospital, Hiroshima

rDepartment of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka

sClinical Research Institute, National Hospital Organization Kyusyu Medical Center

tDepartment of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka

uDepartment of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan

Correspondence to Yoshiyu Takeda, MD, PhD, Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan Tel: +81 76 265 2252; fax: +81 76 234 4251; e-mail:

Abbreviations: ACTH, adrenocorticotropic hormone; APA, aldosterone-producing adenoma; ARR, plasma aldosterone concentration per plasma renin activity ratio; AVS, adrenal venous sampling; CT, computed tomography; EIA, enzyme immunoassay; IHA, idiopathic hyperaldosteronism; JPAS, Japan primary aldosteronism study; PAC, plasma aldosterone concentration; PRA, plasma renin activity; RIA, radioimmunoassay

Received 2 February, 2018

Accepted 12 September, 2018

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