title: Bilateral aldosterone suppression and its resolution in adrenal vein sampling of patients with primary aldosteronism: analysis of data from the WAVES-J study.
abstract: BACKGROUND
  In adrenal vein sampling (AVS) for patients with primary aldosteronism, the contralateral ratio of aldosterone/cortisol (A/C) between the nondominant adrenal vein and the inferior vena cava is one of the best criteria for determining lateralized aldosterone secretion. Despite successful cannulation in some patients, the A/C ratios in the adrenal veins are bilaterally lower than that in the inferior vena cava (bilateral aldosterone suppression; BAS).
  
  
  OBJECTIVE
  To investigate the prevalence of BAS in AVS and how to resolve this condition.
  
  
  METHODS
  Retrospective study involving nine referral centres.
  
  
  METHODS
  Four hundred and ninety-one patients who were confirmed as having primary aldosteronism and had an AVS between January 2006 and December 2013.
  
  
  METHODS
  The prevalence of BAS before and after ACTH stimulation was compared. In addition, we investigated other methods for overcoming BAS.
  
  
  RESULTS
  In 304 patients with successful AVS before ACTH stimulation, BAS was observed in 29 (9·5%). BAS was resolved after ACTH stimulation in 22 patients. In 276 patients with successful AVS both before and after ACTH stimulation, the frequency of BAS was significantly reduced after ACTH (8·7% vs 2·5%, P < 0·01). In a few patients, BAS was also resolved by adding a sampling point at the common trunk of the left adrenal vein and by an alternative drainage vein from the adrenal tumour.
  
  
  CONCLUSIONS
  BAS sometimes occurs in AVS without ACTH stimulation. ACTH stimulation significantly reduces BAS with a single AVS procedure.
authors.affiliation: Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan.
authors.forename: Yui
authors.initials: Y
authors.lastname: Shibayama
authors.affiliation: Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo, Japan. norio.wada@doc.city.sapporo.jp.
authors.forename: Norio
authors.initials: N
authors.lastname: Wada
authors.affiliation: Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Umakoshi
authors.affiliation: Department of Diabetes and Endocrinology, Saiseikai Yokohama Tobu Hospital, Yokohama, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Ichijo
authors.affiliation: Department of Cardiology, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Department of Cardiology, Akashi Medical Center, Akashi, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Kamemura
authors.affiliation: Department of Cardiology, Saiseikai Tondabayashi Hospital, Tondabayashi, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kai
authors.affiliation: Department of Endocrinology and Metabolism, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Sakamoto
authors.affiliation: Department of Endocrinology and Metabolism, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ogo
authors.affiliation: Department of Cardiology, Sanda City Hospital, Sanda, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Internal Medicine, Matsuyama Red Cross Hospital, Matsuyama, Japan.
authors.forename: Tomikazu
authors.initials: T
authors.lastname: Fukuoka
authors.affiliation: Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Tsuiki
authors.affiliation: Department of Public Health, Kitasato University School of Medicine, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Naruse
mesh_terms: D000310:Adrenal Gland Neoplasms; D000311:Adrenal Glands / Q000098:blood supply*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D001800:Blood Specimen Collection; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014682:Vena Cava, Inferior
chemical_list: D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone