We can decide partial adrenalectomy, according to the results of super-selective ACTH-stimulated adrenal vein sampling in patients with primary aldosteronism

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 723-757-Renin-Angiotensin-Aldosterone System/Endocrine Hypertension
Bench to Bedside
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-730
Masao Omura*1, Kohzoh Makita2, Seishi Matsui3, Jun Inoue3, Hiroki Kitoh3, Maki Nagata3, Kunio Yamaguchi3, Yoko Matsuzawa1 and Tetsuo Nishikawa1
1Yokohama Rosai Hosp, Kanagawa, Japan, 2Hikarigaoka Hospital, Tokyo, 3Yokohama Rosai Hospital, Yokohama, Japan
Introduction: Aldosterone-producing adenoma (APA) is a surgically curable hypertension, which is usually treated by unilateral total adrenalectomy. Our new method of supper-selective ACTH-stimulated adrenal vein sampling (SS-ACTH-AVS) can precisely detect the main lesion(s) of hyperaldosteronism. Then we attempted to partially remove the lesions of hyperaldosteronism detected by SS-ACTH-AVS without damaging normal tissues in order to maintain normal steroidogenic activity even after surgical treatment.

Methods: Two-hundred PA-patients, who had desired surgical treatment, underwent SS-ACTH-AVS. Adrenal effluents were sampled at more than two tributary veins of each adrenal gland after ACTH-stimulation. Hyperaldosteronism was diagnosed when concentration of aldosterone was more than 1400ng/dl in adrenal effluents.

Results: There were 105 cases with unilateral PA and 95 with bilateral PA. We could definitely diagnose 65 cases with CT-detectable APA (aldosterone-proucing macroadenoma: APmacroA), 35 with CT-undetectable APA (APmicroA) and 5 with unilateral hyperplasia among 105 unilateral PA-patients after examining by SS-ACTH-AVS. Bilateral hyperaldosteronism was clearly classified as 49 cases with idiopathic hyperaldosteronism (IHA), 18 with bilateral APAs, 20 with IHA complicating non-functioning adenoma (NF) and 8 with IHA complicating cortisol-producing adenoma among 95 cases of bilateral PA by SS-ACTH-AVS. Fifty-two cases among 65 with unilateral APmacroA and 9 cases among 18 bilateral APAs were treated by unilateral partial adrenalectomy for resecting APmacroA, resulting in improvement of hypertension.

Conclusion; SS-ACTH-AVS is promising for choosing how to remove the adrenal lesions inducing hyperaldosteroneima, such as unilateral partial and total adrenalectomy. Moreover, we can easily make the surgical indication for removing the main lesions of hyperaldosteronism, even induced by bilateral APAs after examining by SS-ACTH-AVS, and partial adrenalectomy is safe without disturbing steroidogenic activity.

Nothing to Disclose: MO, KM, SM, JI, HK, MN, KY, YM, TN

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm