title: New diagnostic procedure for primary aldosteronism: adrenal venous sampling under adrenocorticotropic hormone and angiotensin II receptor blocker--application to a case of bilateral multiple adrenal microadenomas.
abstract: Formerly, the incidence of primary aldosteronism (PA) among patients with hypertension was believed to be less than 1%. However, recent studies have suggested a much higher incidence of 6.59%-14.4% among such patients. These findings suggest that many cases of PA caused by small aldosterone-producing adenoma (APA) or idiopathic hyperaldosteronism (IHA) have not been properly diagnosed. To make a more accurate diagnosis in such cases, we developed a new diagnostic procedure for localization of PA, namely, adrenal venous sampling under continuous infusion of adrenocorticotropic hormone (ACTH) and administration of angiotensin II receptor blocker (AVS with ACTH and ARB). Here, we confirm the efficacy of this procedure in the case of a 37-year-old male suspected of having PA. The anticipated diagnosis of PA was based on the presence of hypokalemia, low plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC) and left adrenal mass. However, AVS with ACTH and ARB revealed the presence of bilateral multiple adrenal microadenomas. In the new AVS method, neither ACTH nor the renin-angiotensin system (RAS) exert any influence on the plasma aldosterone level, and a more accurate aldosterone secretary state and a more accurate assessment of the aldosterone secretion of both adrenal glands can be recognized than by conventional AVS. Use of this new method should enable identification of additional cases of APA among patients diagnosed with essential hypertension.
authors.affiliation: Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yamahara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
authors.forename: Akira
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Ken
authors.initials: K
authors.lastname: Masatsugu
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawada
authors.forename: Yasutomo
authors.initials: Y
authors.lastname: Fukunaga
authors.forename: Satsuki
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Sone
authors.forename: Takami
authors.initials: T
authors.lastname: Yurugi
authors.forename: Kazuwa
authors.initials: K
authors.lastname: Nakao
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D000311:Adrenal Glands / Q000098:blood supply; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000450:Aldosterone / Q000097:blood; D057911:Angiotensin Receptor Antagonists; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis*; D008297:Male; D016609:Neoplasms, Second Primary; D044140:Receptor, Angiotensin, Type 1; D014057:Tomography, X-Ray Computed; D014680:Veins
chemical_list: D057911:Angiotensin Receptor Antagonists; D044140:Receptor, Angiotensin, Type 1; D000450:Aldosterone; D000324:Adrenocorticotropic Hormone