Abstract
Adrenal venous blood samples drawn before and after stimulation with adrenocorticotropic hormone (ACTH) were analysed in 32 consecutive patients with primary aldosteronism. Twenty-six patients had aldosterone-producing adenomas and six patients had bilateral hyperplasia.
The ratio of higher to lower levels of aldosterone in the right and left adrenals (aldosterone ratio), aldosterone to cortisol ratio (A/C ratio), and the ratio of higher to lower levels of A/C ratio in the right and left adrenals (ratio of A/C ratios) were calculated. We used both aldosterone ratio and ratio of A/C ratios as a means of diagnosis, a ratio of 3.0 or more for unilateral adenoma, and less than 3.0 for bilateral hyperplasia. With ACTH stimulation, correct characterization of lesions increased from 91% (29 of 32) to 97% (31 of 32) by aldosterone ratio and from 84% (27 of 32) to 97% (30 of 31) by ratio of A/C ratios. Correct diagnosis of bilateral hyperplasia increased markedly from 67% (4 of 6) to 100% and 50% (3 of 6) to 83% (5 of 6) with use of each criterion.
In patients with adenoma, aldosterone ratio rose in 54% (14 of 26) from the pre-stimulation levels. Before stimulation, it ranged from 1.5 to 115.9 (mean 34.8), and afterwards, from 2.1 to 1097.9 (mean 95.5). In contrast, in all patients with bilateral hyperplasia aldosterone ratio fell to less than 3.0 following stimulation with ACTH. With ACTH stimulation, aldosterone ratio increased in patients with adenoma and decreased in patients with hyperplasia.
Measurement of A/C ratio is used to ensure correct access to the adrenal veins, but it was useful in only one case and aldosterone ration was a more reliable diagnostic parameter than ratio of A/C ratios in both pre-and post-ACTH stimulations.
Assay of aldosterone levels and calculation of aldosterone ratios before and after ACTH stimulation were valuable in locating small adenomas in the right and left adrenal and especially in differentiating bilateral hyperplasia from adenoma.
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Tokunaga, K., Nakamura, H., Marukawa, T. et al. Adrenal venous sampling analysis of primary aldosteronism: value of ACTH stimulation in the differentiation of adenoma and hyperplasia. Eur. Radiol. 2, 223–229 (1992). https://doi.org/10.1007/BF00595834
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DOI: https://doi.org/10.1007/BF00595834