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Effect of cosyntropin during adrenal venous sampling on subtype of primary aldosteronism: analysis of surgical outcome.

Abstract：

Objectives:We investigated the clinical significance of ACTH stimulation during 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 even 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 outcomes than did those in U to U group, basal LI could discriminate among patients with better surgical outcomes in U to B group.

journal_name

Eur J Endocrinol

journal_title

European journal of endocrinology

authors

Kobayashi H,Nakamura Y,Abe M,Kurihara I,Itoh H,Ichijo T,Takeda Y,Yoneda T,Katabami T,Tsuiki M,Wada N,Ogawa Y,Sakamoto R,Kawashima J,Sone M,Inagaki N,Yoshimoto T,Yamada T,Okamoto R,Matsuda Y,Fujita M,Watanabe M,

doi

10.1530/EJE-19-0860

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

265-273

issue

3

eissn

0804-4643

issn

1479-683X

pii

EJE-19-0860

journal_volume

182

pub_type

杂志文章,多中心研究

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