Department of Internal Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa.
Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto.
J Hypertens. 2019 May;37(5):1077-1082. doi: 10.1097/HJH.0000000000001964.
Adrenal venous sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism. Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve the success rate of AVS, although the effects on lateralization and its outcomes in unilateral primary aldosteronism are unclear.
The success rate and lateralization indices were examined in a cohort of 2197 Japanese patients with primary aldosteronism from 28 centres who underwent AVS. Outcomes were analysed in 267 patients with aldosterone-producing adenomas (APAs).
ACTH loading during AVS improved the success rate from 67 to 89%, while lateralization indices decreased from 62 to 28%. Bolus, bolus along with continuous infusion or continuous infusion of ACTH did not affect both indices. The absence of clinical success (i.e. unchanged or increased blood pressure) was 33% and absence of biochemical success (persistent hypokalaemia or persistently raised aldosterone-to-renin ratio, or both) was 15%. The clinical and biochemical success rates did not differ between the three groups [lateralization index >2 in basal condition (LIb) and lateralization index >4 after ACTH loading (lateralization indices), and LIb >2 + lateralization indices<4, LIb<2+lateralization indices>4]. The three groups (LIb>4+lateralization indices>4, LIb>4+lateralization indices<4 and LIb<4+lateralization indices>4) did not show any significant differences of clinical and biochemical outcome.
ACTH loading during AVS improved the success rate but decreased laterality. ACTH did not affect the clinical and biochemical outcomes in APA patients. These data showed that the use of ACTH during AVS was helpful for improving the success rate, but did not contribute to better outcomes.
肾上腺静脉采样（AVS）对于确定可通过手术治疗的原发性醛固酮增多症至关重要。促肾上腺皮质激素（ACTH）输注或推注已被报道可提高 AVS 的成功率，尽管其对侧化的影响及其在单侧原发性醛固酮增多症中的结果尚不清楚。
我们检查了 28 个中心的 2197 例原发性醛固酮增多症患者的 AVS 队列中的成功率和侧化指数。对 267 例醛固酮瘤（APAs）患者的结果进行了分析。
AVS 期间进行 ACTH 负荷可将成功率从 67%提高到 89%，而侧化指数则从 62%降低到 28%。推注、推注加连续输注或连续输注 ACTH 均不影响这两个指数。无临床成功（即血压不变或升高）的比例为 33%，无生化成功（低钾血症持续存在或醛固酮/肾素比值持续升高或两者兼有）的比例为 15%。三组间（基础状态下侧化指数>2（LIb）和 ACTH 负荷后侧化指数>4（侧化指数），以及 LIb>2+侧化指数<4、LIb<2+侧化指数>4）的临床和生化成功率没有差异。三组（LIb>4+侧化指数>4、LIb>4+侧化指数<4 和 LIb<4+侧化指数>4）的临床和生化结局均无显著差异。
AVS 期间进行 ACTH 负荷可提高成功率，但降低了侧化程度。ACTH 对 APA 患者的临床和生化结局没有影响。这些数据表明，AVS 期间使用 ACTH 有助于提高成功率，但对改善结局没有帮助。
