オオツキ　ミチオ   Michio Otsuki   大月　道夫    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Impact of adrenocorticotropic hormone stimulation during adrenal venous sampling on outcomes of primary aldosteronism.
掲載誌名	正式名：Journal of hypertension 略　 称：J Hypertens ISSNコード：14735598/02636352
掲載区分	国外
巻・号・頁	37(5),pp.1077-1082
著者・共著者	Takeda Yoshiyu, Umakoshi Hironobu, Takeda Yoshimichi, Yoneda Takashi, Kurihara Isao, Katabami Takuyuki, Ichijo Takamasa, Wada Norio, Yoshimoto Takanobu, Ogawa Yoshihiro, Kawashima Junji, Sone Masakatsu, Takahashi Katsutoshi, Watanabe Minemori, Matsuda Yuichi, Kobayashi Hiroki, Shibata Hirotaka, Kamemura Kohei, Otsuki Michio, Fujii Yuichi, Yamamto Koichi, Ogo Atsushi, Yanase Toshihiko, Suzuki Tomoko, Naruse Mitsuhide,
発行年月	2019/05
概要	BACKGROUND:Adrenal venous sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism. Adrenocorticotropic hormone (ACTH) infusion or bolus has been reported to improve the success rate of AVS, although the effects on lateralization and its outcomes in unilateral primary aldosteronism are unclear.METHODS:The success rate and lateralization indices were examined in a cohort of 2197 Japanese patients with primary aldosteronism from 28 centres who underwent AVS. Outcomes were analysed in 267 patients with aldosterone-producing adenomas (APAs).RESULTS:ACTH loading during AVS improved the success rate from 67 to 89%, while lateralization indices decreased from 62 to 28%. Bolus, bolus along with continuous infusion or continuous infusion of ACTH did not affect both indices. The absence of clinical success (i.e. unchanged or increased blood pressure) was 33% and absence of biochemical success (persistent hypokalaemia or persistently raised aldosterone-to-renin ratio, or both) was 15%. The clinical and biochemical success rates did not differ between the three groups [lateralization index >2 in basal condition (LIb) and lateralization index >4 after ACTH loading (lateralization indices), and LIb >2 + lateralization indices<4, LIb<2+lateralization indices>4]. The three groups (LIb>4+lateralization indices>4, LIb>4+lateralization indices<4 and LIb<4+lateralization indices>4) did not show any significant differences of clinical and biochemical outcome.CONCLUSION:ACTH loading during AVS improved the success rate but decreased laterality. ACTH did not affect the clinical and biochemical outcomes in APA patients. These data showed that the use of ACTH during AVS was helpful for improving the success rate, but did not contribute to better outcomes.
DOI	10.1097/HJH.0000000000001964
PMID	30601318