ICEECE2012 Poster Presentations Adrenal cortex (113 abstracts)
Super-selective ACTH-stimulated adrenal venous sampling can discriminate the main lesion from the normal tissue for doing partial adrenalectomy in unilateral aldosterone-producing adenoma
M. Omura 1 , K. Makita 2 , S. Matsui 1 , J. Inoue 1 , M. Nagata 1 , K. Yamaguchi 1 , Y. Kakuta 1 , Y. Matsuzawa 1 , J. Saito 1 & T. Nishikawa 1
1Yokohama Rosai Hospital, Yokohama, Japan; 2Tokyo-kita Social Insurance Hospital, Tokyo, Japan.
Introduction: Primary aldosteronism (PA) is one of the common diseases, and aldosterone-producing adenoma (APA) is a surgically curable type, which is usually treated by unilateral total adrenalectomy. We had recently developed a new method of supper-selective ACTH-stimulated adrenal venous sampling (SS-ACTH-AVS) for exactly detecting the main lesion(s) of hyperaldosteronemia. Then we attempted to partially remove the unilateral lesion of hyperaldosteronism detected by SS-ACTH-AVS without resecting normal tissues.
Methods: We developed a new micro-catheter to obtain adrenal effluent at intra-adrenal tributary veins. By using that catheter, SS-ACTH-AVS was performed in 50 patients with PA demonstrating unilateral CT-detectable adrenal nodule. Adrenal effluents were sampled at more than 2 intra-adrenal first-degree tributary veins in each adrenal gland after ACTH stimulation. When concentration of aldosterone in effluent sampled at one of the tributary veins connecting to any nodule was >1400 ng/dl and the others were <1400 ng/dl, the nodule was diagnosed as APA. Then, the patients with APA were treated by laparoscopic unilateral partial resection of the nodule. When aldosterone was >1400 ng/dl in all effluents sampled at tributaries of the unilateral adrenal, showing the presence of the nodule and <1400 ng/dl in all effluents sampled at each tributary of the opposite adrenal gland, the patients were also diagnosed as unilateral hyperaldosteronism and treated by unilateral total adrenalectomy.
Results: Thirty patients with CT-detectable APA exactly diagnosed by SS-ACTH-AVS were treated by unilateral partial adrenalectomy. Pathological examinations of resected adrenal glands demonstrate that APAs were completely removed without destruction of their capsules. One year after adrenalectomy, concentrations of aldosterone in peripheral blood samples were normalized in 30 patients treated by partial adrenalectomy as well as in 20 treated by total one.
Discussion: SS-ACTH-AVS is promising for choosing how to remove the adrenal lesion inducing hyperaldosteroneima, such as unilateral partial and total adrenalectomy.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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