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Updated: Jan 2, 2026

A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Left-right differences in adrenal vein sampling for primary aldosteronism.
Arina Miyoshi1, Norio Wada1, Shuhei Baba1
1Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo 060-8604, Japan.
Adrenocorticotropic hormone (ACTH) stimulation during adrenal venous sampling (AVS) for primary aldosteronism (PA) can alter laterality results. ACTH stimulation may decrease unilateral findings and shift the dominant side, potentially leading to overestimation of right-sided disease without stimulation.
Area of Science:
- Endocrinology
- Medical Diagnostics
- Surgical Planning
Background:
- Adrenal venous sampling (AVS) is crucial for diagnosing primary aldosteronism (PA).
- Adrenocorticotropic hormone (ACTH) stimulation is often used to improve AVS success rates.
- The impact of ACTH stimulation on lateralizing PA to the left or right adrenal gland is not well understood.
Purpose of the Study:
- To investigate the effect of ACTH stimulation on the laterality diagnosis in AVS for PA.
- To compare the proportion of unilateral disease detection on the right versus left adrenal glands before and after ACTH stimulation.
Main Methods:
- Retrospective analysis of 167 patients with PA who underwent successful AVS.
- Exclusion of patients with autonomous cortisol secretion.
- Comparison of unilateral disease detection (lateralization index > 4) before and after ACTH stimulation.
Main Results:
- Before ACTH stimulation, right-sided unilateral disease was more frequent (33.5%) than left-sided (13.8%).
- After ACTH stimulation, left-sided disease detection increased (15.6%) while right-sided decreased (10.8%), though not significantly.
- In patients with right unilateral disease pre-stimulation, 60.7% showed a shift to bilateral disease post-stimulation, often associated with milder PA and no CT-detected nodules.
Conclusions:
- ACTH stimulation in AVS can decrease unilateral findings and alter the perceived dominant adrenal side in PA patients.
- Results suggest a potential overestimation of right-sided adrenal disease when ACTH stimulation is omitted.
- Careful consideration of ACTH stimulation is recommended for accurate surgical decision-making in PA.
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