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

JPAS Study Group

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1077-1082
Number of pages6
JournalJournal of hypertension
Volume37
Issue number5
DOIs
Publication statusPublished - 2019 May 1

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Hyperaldosteronism
Adrenocorticotropic Hormone
Aldosterone
Adenoma
Hypokalemia
Renin
Blood Pressure

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of adrenocorticotropic hormone stimulation during adrenal venous sampling on outcomes of primary aldosteronism. / JPAS Study Group.

In: Journal of hypertension, Vol. 37, No. 5, 01.05.2019, p. 1077-1082.

Research output: Contribution to journalArticle

@article{32895418b412425aa43b185353f28047,
title = "Impact of adrenocorticotropic hormone stimulation during adrenal venous sampling on outcomes of primary aldosteronism",
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.",
author = "{JPAS Study Group} and Yoshiyu Takeda and Hironobu Umakoshi and Yoshimichi Takeda and Takashi Yoneda and Isao Kurihara and Takuyuki Katabami and Takamasa Ichijo and Norio Wada and Takanobu Yoshimoto and Yoshihiro Ogawa and Junji Kawashima and Masakatsu Sone and Katsutoshi Takahashi and Minemori Watanabe and Yuichi Matsuda and Hiroki Kobayashi and Hirotaka Shibata and Kohei Kamemura and Michio Otsuki and Yuichi Fujii and Koichi Yamamto and Atsushi Ogo and Toshihiko Yanase and Tomoko Suzuki and Mitsuhide Naruse",
year = "2019",
month = "5",
day = "1",
doi = "10.1097/HJH.0000000000001964",
language = "English",
volume = "37",
pages = "1077--1082",
journal = "Journal of Hypertension",
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TY - JOUR

T1 - Impact of adrenocorticotropic hormone stimulation during adrenal venous sampling on outcomes of primary aldosteronism

AU - JPAS Study Group

AU - Takeda, Yoshiyu

AU - Umakoshi, Hironobu

AU - Takeda, Yoshimichi

AU - Yoneda, Takashi

AU - Kurihara, Isao

AU - Katabami, Takuyuki

AU - Ichijo, Takamasa

AU - Wada, Norio

AU - Yoshimoto, Takanobu

AU - Ogawa, Yoshihiro

AU - Kawashima, Junji

AU - Sone, Masakatsu

AU - Takahashi, Katsutoshi

AU - Watanabe, Minemori

AU - Matsuda, Yuichi

AU - Kobayashi, Hiroki

AU - Shibata, Hirotaka

AU - Kamemura, Kohei

AU - Otsuki, Michio

AU - Fujii, Yuichi

AU - Yamamto, Koichi

AU - Ogo, Atsushi

AU - Yanase, Toshihiko

AU - Suzuki, Tomoko

AU - Naruse, Mitsuhide

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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.

AB - 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.

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U2 - 10.1097/HJH.0000000000001964

DO - 10.1097/HJH.0000000000001964

M3 - Article

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VL - 37

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EP - 1082

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

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