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Horm Metab Res 2021; 53(06): 364-370
DOI: 10.1055/a-1498-6958
Endocrine Care

Effect of Adrenocorticotropic Hormone Stimulation During Simultaneous Bilateral Adrenal Vein Sampling in Primary Aldosteronism

Wei Liu
1   National Clinical Research Center for Metabolic Diseases, Institute of Metabolism and Endocrinology, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
,
Jingjing Zhang
1   National Clinical Research Center for Metabolic Diseases, Institute of Metabolism and Endocrinology, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
,
Yaling Yang
2   Department of Metabolism and Endocrinology, Xuhui Central Hospital, Fudan University, Shanghai, China
,
Yinxin Jin
1   National Clinical Research Center for Metabolic Diseases, Institute of Metabolism and Endocrinology, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
,
Zaizhao Li
1   National Clinical Research Center for Metabolic Diseases, Institute of Metabolism and Endocrinology, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
,
Liting You
1   National Clinical Research Center for Metabolic Diseases, Institute of Metabolism and Endocrinology, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
,
Jianguang Luo
3   Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
,
Xin Su
1   National Clinical Research Center for Metabolic Diseases, Institute of Metabolism and Endocrinology, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Hunan, China
› Author Affiliations Funding This study was supported by the Hunan Provincial Science and Technology Department (2017sk2022, 2020JJ4806, 2020JJ5816).
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Abstract

The aim of the study was to investigate the significance and influence of adrenocorticotropic hormone (ACTH) stimulation in primary aldosteronism (PA) patients with simultaneous bilateral adrenal vein sampling (AVS). All patients diagnosed with PA underwent simultaneous bilateral AVS with ACTH. In 95 patients, the post-ACTH SI significantly increased (p<0.001), and it gradually decreased from t10–t30 after ACTH stimulation (p<0.001). The unsuccessful catheterization decreased after ACTH stimulation. Time points within 20 min after ACTH stimulation were better for sampling, and the selectivity did not increase over longer periods. According to lateralization before and after ACTH stimulation, the patients could be divided into 3 groups (U, unilateral; B, bilateral): U/U , U/B or B/U, and B/B. Compared with the U/U group, in the U/B or B/U and B/B groups, the lateralization index (LI) was lower both at baseline and after ACTH stimulation (p<0.0001), the contralateral index (CLI) was higher after ACTH stimulation (p<0.003), the serum potassium level was higher (p<0.001), and the carbon dioxide combining power (CO2CP) and base excess (BE) levels were lower. In conclusion, in simultaneous bilateral AVS, ACTH stimulation had significant effects on increasing the catheterization selectivity. Lateralization change was observed after stimulation. After ACTH stimulation, fewer patients could be diagnosed with lateralized PA. Patients with consistent lateralized PA showed a more serious phenotype.

Key words

primary aldosteronism - adrenal vein sampling - ACTH stimulation - selectivity index - lateralization index

Supplementary material



Publication History

Received: 17 December 2020

Accepted: 29 April 2021

Article published online:
21 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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