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

研究成果: Article査読

7 被引用数 (Scopus)

抄録

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.

本文言語English
ページ(範囲)145-152
ページ数8
ジャーナルHypertension Research
25
2
DOI
出版ステータスPublished - 2002
外部発表はい

ASJC Scopus subject areas

  • 内科学
  • 生理学
  • 循環器および心血管医学

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