The occurrence of apparent bilateral aldosterone suppression in adrenal vein sampling for primary aldosteronism

Yui Shibayama, Norio Wada, Mitsuhide Naruse, Isao Kurihara, Hiroshi Ito, Takashi Yoneda, Yoshiyu Takeda, Hironobu Umakoshi, Mika Tsuiki, Takamasa Ichijo, Hisashi Fukuda, Takuyuki Katabami, Takanobu Yoshimoto, Yoshihiro Ogawa, Junji Kawashima, Yuichi Ohno, Masakatsu Sone, Megumi Fujita, Katsutoshi Takahashi, Hirotaka ShibataKohei Kamemura, Yuichi Fujii, Koichi Yamamoto, Tomoko Suzuki

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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 PAwho 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.

Original languageEnglish
Pages (from-to)398-407
Number of pages10
JournalJournal of the Endocrine Society
Volume2
Issue number5
DOIs
Publication statusPublished - May 1 2018

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All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism

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