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ACTH in adrenal vein sampling reduces apparent bilateral aldosterone suppression
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Among patients with primary aldosteronism undergoing adrenal vein sampling, the administration of adrenocorticotropic hormone, or ACTH, before the procedure reduced the incidence of apparent bilateral aldosterone suppression, improving the ability to diagnose disease subtype, according to findings from researchers in Japan.
The results of adrenal vein sampling (AVS) are inconclusive in some patients because of a bilaterally lower aldosterone-to-cortisol ratio in the adrenal veins vs. the inferior vena cava despite successful cannulation, according to study background.
“Recently, we demonstrated using data from the West Japan adrenal vein sampling study (WAVES-J) that this phenomenon was observed in 9.5% of the patients who underwent AVS without ACTH administration, and that in 92% of these patients, it was resolved by ACTH administration,” Norio Wada, MD, PhD, of the department of diabetes and endocrinology at Sapporo City General Hospital in Japan, and colleagues wrote. “In this study, we term this phenomenon as apparent bilateral aldosterone suppression.”
In a retrospective study, Wada and colleagues analyzed data from 1,689 patients with primary aldosteronism who underwent AVS between 2006 and October 2016, using data from the multicenter Japan Primary Aldosteronism Study. Researchers investigated the prevalence of apparent bilateral aldosterone suppression in two different vein sampling combinations with and without ACTH administration: the right adrenal vein and the central vein of the left adrenal, or the right adrenal vein and the common trunk of the left adrenal.
Within the cohort, 742 patients underwent attempted cannulation of the right adrenal vein and both the central vein and common trunk with ACTH administration, and 591 patients were successfully cannulated.
Researchers found that the prevalence of apparent bilateral aldosterone suppression with ACTH administration was lower when compared with patients who underwent AVS without ACTH administration (7.6% vs. 18%; P < .001). In patients who underwent AVS with ACTH administration, there were no significant between-group differences in prevalence of apparent bilateral aldosterone suppression when stratified by sampling procedures in the left adrenal vein (5.6%) vs. sampling at the central vein and common trunk (5.4%).
The researchers noted that, although the frequency of apparent bilateral aldosterone suppression in AVS was demonstrated in a large cohort, the variation in the protocols of AVS among participating centers might have effects on the occurrence of apparent bilateral aldosterone suppression.
“The effect on [apparent bilateral aldosterone suppression] between a sequential and a simultaneous AVS could not be clarified,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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