Does ACTH Stimulation Improve Diagnostic Significance of Adrenal Venous Sampling in Lateralizing Primary Aldosteronism?(Significance of ACTH-loaded adrenal venous sampling in adrenal primary aldosteronism,Proceedings of the 2nd Conference on Adrenal Venous Sampling)

摘要

The aim of the study was to ascertain whether combination of ACTH stimulation improves diagnostic value of adrenal venous sampling in lateralizing primary aldosteronism. Plasma aldosterone (Aldo) and cortisol (C) concentration in the adrenal vein was determined before and after ACTH administration (synthetic 1-24 ACTH, 125 mcg/100 ml/hr for 60 min) in 20 patients who were suggested to be primary aldosteronism. Twelve patients with a definite tumor larger than 8 mm in its diameter in one side of the adrenal on CT scan were indicated to adrenalectomy and the diagnosis was confirmed (Surgery group). Eight patients without a definite tumor on adrenal CT scan were subjected to medical treatment (Non-surgery group). The tumor side vs. contralateral side ratio of Aldo (Aldo ratio) and Aldo/C (Aldo/C ratio) before and after ACTH stimulation were compared. In the non-surgery group, the higher side vs. lower side ratio of Aldo (Aldo ratio) and Aldo/C (Aldo/C ratio) were compared. In the surgery group, although both Aldo ratio and Aldo/C ratio significantly increased in 3 patients after ACTH stimulation, both of the ratios were unchanged and even decreased in 9 patients. In the non-surgery group, although the higher to lower Aldo ratio significantly increased in 3 patients after ACTH stimulation, it was unchanged or decreased in rest of the patients. The higher to lower Aldo/C ratio was unchanged or decreased in all the patients of the non-surgery group. All the patients in which Aldo ratio and Aldo/C ratio increased significantly after ACTH stimulation showed a sizable difference of these ratios even before ACTH stimulation. Combination of ACTH stimulation does not improve diagnostic value of adrenal venous sampling in lateralizing tumor side of primary aldosteronism, especially if a definite adrenal tumor is demonstrated on CT scan.