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

Takeda, Yoshiyu; Umakoshi, Hironobu; Takeda, Y.; Yoneda, Takashi; Kurihara, Isao; Katabami, Takuyuki; Ichijo, Takamasa; Wada, Norio; Yoshimoto, Takanobu; Ogawa, Yoshihiro; Kawashima, Junji; Sone, Masakatsu; Takahashi, K.; Watanabe, Minemori; Matsuda, Yuichi; Kobayashi, Hiroki; Shibata, Hirotaka; Kamemura, Kohei; Otsuki, Michio; Fujii, Yukihiko; Yamamto, Koichi; Ogo, Atsushi; Yanase, Toshihiko; Naruse, Mitsuhide

doi:10.1097/hjh.0000000000001964

Cited by 27 publications

(43 citation statements)

References 24 publications

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“…In our previous study, we demonstrated that ACTH stimulation during AVS did not affect the clinical and biochemical outcomes (18). This discrepancy may be due to the fact that the sample size of the present study was 27% higher than that of the previous study, thereby enhancing the statistical power of the present study.…”

Section: Discussioncontrasting

confidence: 61%

“…In particular, it has been widely discussed whether we should use ACTH stimulation during AVS; however, no consensus has been reached. In our previous study, we demonstrated that ACTH stimulation increases the success rate of bilateral selective catheterization (18). However, we could not show whether or not ACTH stimulation affected the outcome of adrenalectomy due to the inadequate sample size.…”

Section: Discussionmentioning

confidence: 57%

“…Detailed information about the AVS procedure has been described previously (17,18). Briefly, adrenal blood samples were obtained via sequential cannulation by the percutaneous femoral vein approach.…”

Section: Adrenal Venous Samplingmentioning

confidence: 99%

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Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome

Kobayashi

Nakamura

Abe

et al. 2020

European Journal of Endocrinology

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Objectives We investigated the clinical significance of ACTH stimulation during adrenal venous sampling (AVS) by surgical outcome of primary aldosteronism (PA). Design Multicenter retrospective study by Japan PA study. Method We allocated 314 patients with both basal and ACTH-stimulated AVS data who underwent adrenalectomy to three groups: basal lateralization index (LI) ≥2 with ACTH-stimulated LI ≥4 on the ipsilateral side (Unilateral (U) to U group, n = 245); basal LI <2 with ACTH-stimulated LI ≥4 (Bilateral (B) to U group, n = 15); and basal LI ≥2 with ACTH-stimulated LI <4 (U to B group, n = 54). We compared surgical outcomes among the groups using the Primary Aldosteronism Surgical Outcome (PASO) criteria. Results Compared with U to U group, U to B group had poor clinical and biochemical outcomes and low rates of adrenal adenoma as pathological findings (P = 0.044, 0.006, and 0.048, respectively), although there were no significant differences between U to U and B to U groups. All patients in U to B group with clinical and biochemical benefits, however, had adrenal adenoma as pathological findings and could be well differentiated from those with poor surgical outcomes via basal LI (>8.3), but not ACTH-stimulated LI. These results were similar even when we defined each group based on a cut-off value of 4 for basal LI. Conclusions Although PA patients in U to B group had worse surgical outcomes than did those in U to U group, basal LI could discriminate among patients with better surgical outcomes in U to B group.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 57%

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Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome

Kobayashi

Nakamura

Abe

et al. 2020

European Journal of Endocrinology

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“…However, ACTH stimulation is administered in only about 40% of referral units worldwide due to concerns of lowering lateralization [92]. It was reported in a recent study that ACTH loading during AVS irrespective of approach improved the rate of successful cannulation from 67% to 89% and decreased lateralisation indices from 62% to 28%, but did not interfere the clinical and biochemical success in patients with APA [93].…”

Section: Subtype Differentiationmentioning

confidence: 99%

Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

Yang

Reincke

Williams

2020

Best Practice & Research Clinical Endocrinology & Metab

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Primary aldosteronism (PA) is the most common potentially curable form of hypertension. The overproduction of aldosterone leads to an increased risk of cardiovascular and cerebrovascular events as well as adverse effects to the heart and kidney and psychological disorders. PA is mainly caused by unilateral aldosterone excess due to an aldosterone-producing adenoma or bilateral excess due to bilateral adrenocortical hyperplasia. The diagnostic work-up of PA comprises three steps: screening, confirmatory testing and differentiation of unilateral surgically-correctable forms from medically treated bilateral PA. These specific treatments can mitigate or reverse the increased risks associated with PA. Herein we summarise the prevalence, outcomes and current and future clinical approaches for the diagnosis of primary aldosteronism.

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“…If only CT imaging is used to determine adrenal lateralization, 14.6 and 19.1% patients would bear inappropriate adrenalectomy or inappropriate exclusion from surgery, and surgery on the wrong adrenal side would have occurred in 3.9% [ 29 ]. Although some studies showed that the use of ACTH during AVS was helpful for improving the success rate [ 30 , 31 ]. However, a recent study suggested that stimulated AVS with ACTH did not contribute to better clinical and biochemical outcomes [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Determination of adrenal hypersecretion in primary Aldosteronism without aldosterone-production adenomas

et al. 2021

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Background Primary aldosteronism (PA) is highly prevalent in hypertensive population. Adrenal vein sampling (AVS) is the only procedure to assess adrenal aldosterone hypersecretion in PA. PA patients without aldosterone-producing adenomas (APA) frequently have unilateral aldosterone hypersecretion (UAH). These patients could bear inappropriate adrenalectomy without AVS. This study aims to identify which clinical characteristics should be recommended to perform AVS in these PA patients. Methods This study was performed from January 2018 to July 2019 at a center for hypertension and metabolic diseases. Adrenal computed tomography (CT) scan, biochemical evaluation, and AVS were performed. Results Total 141 patients were included in this study. Aldosterone to renin ratio (ARR) after confirmatory test is highly associated with adrenal laterality. The specificity of ARR > 10 (ng/dL)/(mU/L) after confirmatory test is 100%. After confirmatory test, patients with ARR > 10 (ng/dL)/(mU/L) had higher plasma aldosterone concentration and incidences of ischemic heart diseases and renal damage(p < 0.05). Conclusions After confirmatory tests, ARR > 10 (ng/dL)/(mU/L) indicates adrenal laterality, with increasingly cardiorenal damage in PA patients without APA. Thus, AVS should be recommended in these patients before surgery. Trial registration NCT03398785, Date of Registration: December 24, 2017.

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

Cited by 27 publications

References 24 publications

Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome

Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome

Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

Determination of adrenal hypersecretion in primary Aldosteronism without aldosterone-production adenomas

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