Shibayama Yui, Wada Norio, Naruse Mitsuhide, Kurihara Isao, Ito Hiroshi, Yoneda Takashi, Takeda Yoshiyu, Umakoshi Hironobu, Tsuiki Mika, Ichijo Takamasa, Fukuda Hisashi, Katabami Takuyuki, Yoshimoto Takanobu, Ogawa Yoshihiro, Kawashima Junji, Ohno Yuichi, Sone Masakatsu, Fujita Megumi, Takahashi Katsutoshi, Shibata Hirotaka, Kamemura Kohei, Fujii Yuichi, Yamamoto Koichi, Suzuki Tomoko
Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan.
Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
J Endocr Soc. 2018 Mar 22;2(5):398-407. doi: 10.1210/js.2017-00481. eCollection 2018 May 1.
In adrenal venous sampling (AVS) for patients with primary aldosteronism (PA), apparent bilateral aldosterone suppression (ABAS), defined as lower aldosterone/cortisol ratios in the bilateral adrenal veins than that in the inferior vena cava, is occasionally experienced. ABAS is uninterpretable with respect to lateralization of excess aldosterone production. We previously reported that ABAS was not a rare phenomenon and was significantly reduced after adrenocorticotropic hormone (ACTH) administration.
To validate the effects of ACTH administration and adding sampling positions in the left adrenal vein on the prevalence of ABAS in the larger Japan Primary Aldosteronism Study.
The data from 1689 patients with PA who underwent AVS between January 2006 and October 2016 were studied. All patients in the previous study, the West Japan Adrenal Vein Sampling study, were excluded.
The prevalence of ABAS was investigated at two sampling positions in the left adrenal vein, the central vein and the common trunk, without and with ACTH administration.
The prevalence of ABAS with ACTH administration was significantly lower than that without ACTH administration [without ACTH vs with ACTH: 79/440 (18.0%) vs 45/591 (7.6%); < 0.001]. With ACTH administration, the prevalence of ABAS was not different between the sampling position, at the central vein and at the common trunk [33/591 (5.6%) vs 32/591 (5.4%); = 1.00].
The effectiveness of ACTH administration for the reduction of ABAS in AVS regardless of the sampling position in the left adrenal vein was confirmed in the larger cohort.
在原发性醛固酮增多症（PA）患者的肾上腺静脉采样（AVS）中，偶尔会出现明显双侧醛固酮抑制（ABAS），即双侧肾上腺静脉中的醛固酮/皮质醇比值低于下腔静脉中的该比值。ABAS对于醛固酮过量分泌的定位无法进行解读。我们之前报道过ABAS并非罕见现象，且在给予促肾上腺皮质激素（ACTH）后显著降低。
在规模更大的日本原发性醛固酮增多症研究中，验证给予ACTH以及在左肾上腺静脉增加采样位置对ABAS发生率的影响。
对2006年1月至2016年10月期间接受AVS的1689例PA患者的数据进行研究。之前研究即西日本肾上腺静脉采样研究中的所有患者被排除。
在左肾上腺静脉的两个采样位置（中央静脉和共同主干），分别在未给予和给予ACTH的情况下，调查ABAS的发生率。
给予ACTH时ABAS的发生率显著低于未给予ACTH时[未给予ACTH与给予ACTH：79/440（18.0%）对45/591（7.6%）；<0.001]。给予ACTH时，中央静脉和共同主干这两个采样位置的ABAS发生率无差异[33/591（5.6%）对32/591（5.4%）；=1.00]。
在更大的队列中证实了，无论左肾上腺静脉的采样位置如何，给予ACTH在AVS中减少ABAS是有效的。
