Yoshiyu Takeda1, Hironobu Umakoshi2, Yoshimichi Takeda1, Takashi Yoneda1, Isao Kurihara3, Takuyuki Katabami4, Takamasa Ichijo5, Norio Wada6, Takanobu Yoshimoto7, Yoshihiro Ogawa7, Junji Kawashima8, Masakatsu Sone9, Katsutoshi Takahashi10, Minemori Watanabe11, Yuichi Matsuda12, Hiroki Kobayashi13, Hirotaka Shibata14, Kohei Kamemura15, Michio Otsuki16, Yuichi Fujii17, Koichi Yamamto18, Atsushi Ogo19, Toshihiko Yanase20, Tomoko Suzuki21, Mitsuhide Naruse2. 1. Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa. 2. Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto. 3. Department of Endocrinology, Metabolism and Nephrology, School of Medicine Keio University, Tokyo. 4. Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital. 5. Department of Endocrinology and Metabolism, Saiseikai, Yokohamashi Tobu Hospital, Yokohama. 6. Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo. 7. Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University, Tokyo. 8. Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto University, Kumamoto. 9. Department of Diabetes, Endocrinology and Nutrition Kyoto University, Kyoto. 10. Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo. 11. Department of Endocrinology and Diabetes, Okazaki City Hospital, Okazaki. 12. Department of Cardiology, Sanda City Hospital, Sanda. 13. Division of Nephrology, Hypertension and Endocrinology, Nihon University School of Medicine, Tokyo. 14. Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu. 15. Department of Cardiology, Akashi Medical Center, Akashi. 16. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka. 17. Department of Cardiology, JR Hiroshima Hospital, Hiroshima. 18. Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Osaka. 19. Clinical Research Institute, National Hospital Organization Kyusyu Medical Center. 20. Department of Endocrinology and Diabetes Mellitus, Faculty of Medicine, Fukuoka University, Fukuoka. 21. Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan.
Abstract
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.
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.
Authors: Taweesak Wannachalee; Lili Zhao; Kazutaka Nanba; Aya T Nanba; James J Shields; William E Rainey; Richard J Auchus; Adina F Turcu Journal: J Clin Endocrinol Metab Date: 2019-12-01 Impact factor: 5.958
Authors: Nicholas Yozamp; Gregory L Hundemer; Marwan Moussa; Jonathan Underhill; Tali Fudim; Barry Sacks; Anand Vaidya Journal: Hypertension Date: 2021-05-17 Impact factor: 9.897