New diagnostic procedure for primary aldosteronism: Adrenal venous sampling under adrenocorticotropic hormone and angiotensin II receptor blocker - Application to a case of bilateral multiple adrenal microadenomas

Kenichi Yamahara, Hiroshi Itoh, Akira Yamamoto, Hironobu Sasano, Ken Masatsugu, Naoki Sawada, Yasutomo Fukunaga, Satsuki Sakaguchi, Masakatsu Sone, Takami Yurugi, Kazuwa Nakao

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Formerly, the incidence of primary aldosteronism (PA) among patients with hypertension was believed to be less than 1%. However, recent studies have suggested a much higher incidence of 6.59%-14.4% among such patients. These findings suggest that many cases of PA caused by small aldosterone-producing adenoma (APA) or idiopathic hyperaldosteronism (IHA) have not been properly diagnosed. To make a more accurate diagnosis in such cases, we developed a new diagnostic procedure for localization of PA, namely, adrenal venous sampling under continuous infusion of adrenocorticotropic hormone (ACTH) and administration of angiotensin II receptor blocker (AVS with ACTH and ARB). Here, we confirm the efficacy of this procedure in the case of a 37-year-old male suspected of having PA. The anticipated diagnosis of PA was based on the presence of hypokalemia, low plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC) and left adrenal mass. However, AVS with ACTH and ARB revealed the presence of bilateral multiple adrenal microadenomas. In the new AVS method, neither ACTH nor the renin-angiotensin system (RAS) exert any influence on the plasma aldosterone level, and a more accurate aldosterone secretary state and a more accurate assessment of the aldosterone secretion of both adrenal glands can be recognized than by conventional AVS. Use of this new method should enable identification of additional cases of APA among patients diagnosed with essential hypertension.

Original languageEnglish
Pages (from-to)145-152
Number of pages8
JournalHypertension Research
Volume25
Issue number2
DOIs
Publication statusPublished - 2002 May 14
Externally publishedYes

Keywords

  • Adrenal microadenoma
  • Adrenal venous sampling
  • Adrenocorticotropic hormone (ACTH)
  • Angiotensin II receptor blocker (ARB)
  • Primary aldosteronism

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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