ACTH負荷下副腎静脈サンプリングを行った非典型的副腎性原発性アルドステロン症の2例(原発性アルドステロン症におけるACTH負荷副腎静脈サンプリングの意義,第2回副腎静脈サンプリング研究会,プロシーディングス)

概要

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Patients with primary aldosteronism (PA) are increasing in number in our department in last two years. We have performed ACTH-loaded adrenal venous sampling (AVS), which has been reported to be very useful method to determine which side of adrenal glands possesses excessive aldosterone excretion since 2001. Here, we reported two atypical cases underwent AVS. Case 1 was an adrenal myelolipoma and ACTH-loaded AVS revealed that it was an aldosterone-producing tumor. After resection of the tumor, the patient showed normal blood pressure without medicine. Case 2 had a cystic mass in the right side of adrenal gland. Even though both furosemide-upright test and captopril test suggested that the case was PA, ACTH-loaded AVS showed that both sides of adrenal glands excrete excessive aldosterone. Based on the data of the AVS, we prescribed spironolactone to the patient. As shown in this report, ACTH-loaded AVS is a powerful tool for diagnosis of PA, however some cases such as Case 2 show controversial result in ACTH-loaded AVS. Multicenter study of ACTH-loaded AVS should be required for improvement of diagnosis of PA.
東京女子医科大学の論文