Effects of ACTH Loading for the Diagnostic Performance of Adrenal Venous Sampling for Subtyping Primary Aldosteronism

Presentation Number: SUN 511
Date of Presentation: April 2nd, 2017

Yoshiyu Takeda*1, Yoshimichi Takeda1, Takashi Yoneda1, Mitsuhiro Kometani1, Takuyuki Katabami2, Isao Kurihara3, Norio Wada4, Takamasa Ichijo5, Takanobu Yoshimoto6, Junji Kawashima7, Mika Tsuiki8, Mitsuhide Naruse8 and Jpas Investigators9
1Kanazawa University, Kanazawa, Japan, 2St Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama-shi Kanagawa, Japan, 3Keio University School of Medicine, Tokyo, Japan, 4Sapporo City General Hospital, Sapporo, Japan, 5Saiseikai Yokohamashi Tobu Hospital, Tokyo, Japan, 6Tokyo Medical and Dental University, Tokyo, Japan, 7Kumamoto University, Kumamoto, Japan, 8National Hospital Organization Kyoto Medical Center, Kyoto, Japan, 9Kyoto Medical Center, Kyoto, Japan


Adrenal vein sampling (AVS) is used for determining treatment options for primary aldosteronism (PA). Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve AVS success rates by increasing cortisol secretion, but effects on lateralization are controversial. Aim of the study was to investigate the effects of ACTH loading for subtyping primary aldosteronism. The study was conducted as the multi-center collaborative study in Japan (JPAS). Methods: Twenty-two hospitals participated into the study. AVS data from 1865 patients were analyzed. Catheterization was judged to be successful if selectivity index was >2 before and >5 after ACTH loading. Lateralized ratio (LR) >2 before and >4 after ACTH loading was used for subtype classification. Three hundred and forty one patients with aldosterone-producing adenoma (APA) which were pathologically diagnosed were studied as the same methods. Results: Success rate in the right adrenal vein before and after ACTH loading was 64%and 93%; left adrenal vein was 63% and 89%, respectively. ACTH loading significantly decreased LR (p<0.05). In APA patients ACTH loading in AVS increased success rate but did not improve the proper diagnosis rate. Conclusion: The data of the JPAS showed that ACTH loading in AVS was useful to succeed the catheterization, however the proper diagnosis of lateralization was not improved. (Suppoted by AMED:15Aek0109122)


Disclosure: TK: Protocol review committee, ONO-Pharma, Investigator, ONO-Pharma. MT: Investigator, ONO-Pharma. Nothing to Disclose: YT, YT, TY, MK, IK, NW, TI, TY, JK, MN, JI