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Abstract
Context
In adrenal venous sampling (AVS) for patients with primary aldosteronism (PA), apparent bilateral aldosterone suppression (ABAS), defined as lower aldosterone/cortisol ratios in the bilateral adrenal veins than that in the inferior vena cava, is occasionally experienced. ABAS is uninterpretable with respect to lateralization of excess aldosterone production. We previously reported that ABAS was not a rare phenomenon and was significantly reduced after adrenocorticotropic hormone (ACTH) administration.
Objective
To validate the effects of ACTH administration and adding sampling positions in the left adrenal vein on the prevalence of ABAS in the larger Japan Primary Aldosteronism Study.
Patients
The data from 1689 patients with PA who underwent AVS between January 2006 and October 2016 were studied. All patients in the previous study, the West Japan Adrenal Vein Sampling study, were excluded.
Outcome Measurements
The prevalence of ABAS was investigated at two sampling positions in the left adrenal vein, the central vein and the common trunk, without and with ACTH administration.
Results
The prevalence of ABAS with ACTH administration was significantly lower than that without ACTH administration [without ACTH vs with ACTH: 79/440 (18.0%) vs 45/591 (7.6%); P < 0.001]. With ACTH administration, the prevalence of ABAS was not different between the sampling position, at the central vein and at the common trunk [33/591 (5.6%) vs 32/591 (5.4%); P = 1.00].
Conclusions
The effectiveness of ACTH administration for the reduction of ABAS in AVS regardless of the sampling position in the left adrenal vein was confirmed in the larger cohort.
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Details
1 Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan
2 Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
3 Division of Endocrinology, Metabolism, and Nephrology, Keio University, Tokyo, Japan
4 Division of Endocrinology and Hypertension, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
5 Department of Diabetes and Endocrinology, Saiseikai Yokohama Tobu Hospital, Yokohama, Japan
6 Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
7 Department of Molecular Endocrinology and Metabolism, Graduate School of Medicine, Tokyo Medical Dental University, Tokyo, Japan
8 Department of Molecular Endocrinology and Metabolism, Graduate School of Medicine, Tokyo Medical Dental University, Tokyo, Japan; Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
9 Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
10 Department of Diabetes, Endocrinology, and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
11 Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
12 Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan; Department of Metabolism, Showa General Hospital, Kodaira, Japan
13 Department of Endocrinology, Metabolism, Rheumatology, and Nephrology, Faculty of Medicine, Oita University, Yuhu, Japan
14 Department of Cardiology, Akashi Medical Center, Akashi, Japan
15 Department of Cardiology, JR Hiroshima Hospital, Hiroshima, Japan
16 Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
17 Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan