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- Title
Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome.
- Authors
Kobayashi, Hiroki; Nakamura, Yoshihiro; Abe, Masanori; Kurihara, Isao; Itoh, Hiroshi; Ichijo, Takamasa; Takeda, Yoshiyu; Yoneda, Takashi; Katabami, Takuyuki; Tsuiki, Mika; Wada, Norio; Ogawa, Yoshihiro; Sakamoto, Ryuichi; Kawashima, Junji; Sone, Masakatsu; Inagaki, Nobuya; Yoshimoto, Takanobu; Yamada, Tetsuya; Okamoto, Ryuji; Matsuda, Yuichi
- Abstract
Objectives: We investigated the clinical significance of ACTH stimulation d uring adrenal venous sampling (AVS) by surgical outcome of primary aldosteronism (PA). Design: Multicenter retrospective study by Japan PA study. Method: We allocated 314 patients with both basal and ACTH-stimulated AVS data who underwent adrenalectomy to three groups: basal lateralization index (LI) =2 with ACTH-stimulated LI =4 on the ipsilateral side (Unilateral (U) to U group, n = 245); basal LI <2 with ACTH-stimulated LI =4 (Bilateral (B) to U group, n = 15); and basal LI =2 with ACTH-stimulated LI <4 (U to B group, n = 54). We compared surgical outcomes among the groups using the Primary Aldosteronism Surgical Outcome (PASO) criteria. Results: Compared with U to U group, U to B group had poor clinical and biochemical outcomes and low rates of adrenal adenoma as pathological findings (P = 0.044, 0.006, and 0.048, respectively), although there were no significant differences between U to U and B to U groups. All patients in U to B group with clinical and biochemical benefits, however, had adrenal adenoma as pathological findings and could be well differentiated from those with poor surgical outcomes via basal LI (>8.3), but not ACTH-stimulated LI. These results were similar ev en when we defined each group based on a cut-off value of 4 for basal LI. Conclusions: Although PA patients in U to B group had worse surgical outcom es than did those in U to U group, basal LI could discriminate among patients with better surgical outcomes in U to B group.
- Subjects
HYPERALDOSTERONISM; ADRENOCORTICOTROPIC hormone
- Publication
European Journal of Endocrinology, 2020, Vol 182, Issue 3, p265
- ISSN
0804-4643
- Publication type
Article
- DOI
10.1530/EJE-19-0860