title: Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling.
abstract: Accurate localization of aldosterone-producing adenoma (APA) is essential for the treatment of primary aldosteronism (PA). In order to confirm the clinical usefulness of adrenal venous sampling (AVS), we retrospectively studied 87 cases of PA in whom AVS was conducted. We collected right and left adrenal venous effluents simultaneously before and after adrenocorticotropic hormone (ACTH) stimulation for measurements of aldosterone concentration (A) and cortisol concentration (C). Based on AVS results, we judged 66 cases as having unilateral aldosterone hypersecretion and the remaining 21 cases as having no apparent laterality. Of the above 66 subjects, 61 underwent laparoscopic removal of the adrenal gland through a retroperitoneal approach. The presence of APA was histopathologically confirmed, and blood pressure decreased significantly with normalization of plasma aldosterone concentration (PAC) in all cases. The receiver operator characteristics (ROC) curve analysis between the operated and no-apparent-laterality groups revealed that the ratio of A/C on the higher side to A/C on the lower side (A/C ratio) after ACTH stimulation is a useful index, with a cutoff value of 2.6, a sensitivity of 0.98 and a specificity of 1.0. The ROC curve analysis between the APA side and contralateral side within the operated patients revealed that the cutoff value of A was 1,340 ng/dL, with a sensitivity of 0.92 and a specificity of 1.00. Our results indicate the usefulness of simultaneous AVS and ACTH stimulation for localizing APA.
authors.affiliation: Department of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, Japan. fsatoh@mail.tains.tohoku.ac.jp
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.forename: Takaaki
authors.initials: T
authors.lastname: Abe
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanemoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakamura
authors.forename: Michiaki
authors.initials: M
authors.lastname: Abe
authors.forename: Akira
authors.initials: A
authors.lastname: Uruno
authors.forename: Ryo
authors.initials: R
authors.lastname: Morimoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sato
authors.forename: Kei
authors.initials: K
authors.lastname: Takase
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ishidoya
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
authors.forename: Takashi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ishibashi
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Ito
mesh_terms: D000236:Adenoma / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D000324:Adrenocorticotropic Hormone; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood* / Q000502:physiology; D001800:Blood Specimen Collection / Q000379:methods*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone