title: Adrenal Venous Sampling in Patients With Positive Screening but Negative Confirmatory Testing for Primary Aldosteronism.
abstract: Adrenal venous sampling is considered to be the most reliable diagnostic procedure to lateralize aldosterone excess in primary aldosteronism (PA). However, normative criteria have not been established partially because of a lack of data in non-PA hypertensive patients. The aim of the study was to investigate aldosterone concentration and its gradient in the adrenal vein of non-PA hypertensive patients. We retrospectively studied the results of cosyntropin-stimulated adrenal venous sampling in 40 hypertensive patients who showed positive screening testing but negative results in 2 confirmatory tests/captopril challenge test and saline infusion test. Plasma aldosterone concentration, aldosterone/cortisol ratio, its higher/lower ratio (lateralization index) in the adrenal vein with cosyntropin stimulation were measured. Median plasma aldosterone concentration in the adrenal vein was 25 819 pg/mL (range, 5154-69 920) in the higher side and 12 953 (range, 1866-36 190) pg/mL in the lower side (P<0.001). There was a significant gradient in aldosterone/cortisol ratio between the higher and the lower sides (27.2 [5.4-66.0] versus 17.3 [4.0-59.0] pg/mL per μg/dL;P<0.001) with lateralization index ranging from 1.01 to 3.87. The aldosterone lateralization gradient was between 1 to 2 in 32 patients and 2 to 4 in 8 patients. None of the patients showed lateralization index ≥4. The present study demonstrated that plasma aldosterone concentration in the adrenal veins showed significant variation and lateralization gradient even in non-PA hypertensive patients. Adrenal venous sampling aldosterone lateralization gradients between 2 and 4 should be interpreted with caution in patients with PA because these gradients can be found even in patients with negative confirmatory testing for PA.
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Hironobu
authors.initials: H
authors.lastname: Umakoshi
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.). mnaruse@kyotolan.hosp.go.jp.
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Naruse
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Norio
authors.initials: N
authors.lastname: Wada
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Takamasa
authors.initials: T
authors.lastname: Ichijo
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Kohei
authors.initials: K
authors.lastname: Kamemura
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kai
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Tomikazu
authors.initials: T
authors.lastname: Fukuoka
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Sakamoto
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogo
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Tomoko
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Nanba
authors.affiliation: From the Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (H.U., M.N., K.N., M.T.); Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan (N.W.); Department of Diabetes and Endocrinology, Saiseikai Yokohama City Toubu Hospital, Yokohama City, Japan (T.I.); Department of Cardiology, Akashi Medical Center, Akashi, Japan (K.K.); Department of Cardiology, Sanda City Hospital, Sanda, Japan (Y.M.); Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan (Y.F.); Department of Cardiology, Saiseikai Tondabayashi Hospital, Osaka, Japan (T.K.); Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan (T.F.); Department of Metabolism and Endocrinology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (R.S., A.O.); and Department of Public Health, Kitasato University School of Medicine, Kanagawa, Japan (T.S.).
authors.forename: Mika
authors.initials: M
authors.lastname: Tsuiki
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply; D000367:Age Factors; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D015331:Cohort Studies; D003366:Cosyntropin / Q000494:pharmacology; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis; D006973:Hypertension / Q000097:blood* / Q000175:diagnosis; D007564:Japan; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012016:Reference Values; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers; D014680:Veins
chemical_list: D003366:Cosyntropin; D000450:Aldosterone
keywords: aldosterone; hyperaldosteronism; hypertension; primary hyperaldosteronism