Impact of Conducting Adrenal Venous Sampling in the Morning Versus Afternoon in Primary Aldosteronism

Figures

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  Figure 1.. Comparison of the cortisol levels in the inferior vena cava blood during AVS. In both AM-AVD and PM-AVS groups, cortisol concentrations in the IVC significantly increased by ACTH stimulation. Regarding basal AVS, cortisol concentrations were significantly higher in the AM-AVS group than in the PM-AVS group. Data were compared between the 2 groups using the Mann–Whitney U test; data are presented in a box-and-hide diagram. ACTH, adrenocorticotropic hormone; ACTH-s, ACTH-stimulated; AVS, adrenal venous sampling; IVC, inferior vena cava.

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  Figure 2.. Comparison of SI of the left and right adrenal veins during basal and ACTH-s AVS in AM-AVS and PM-AVS groups. SI significantly increased by ACTH stimulation in both AM-AVS and PM-AVS groups, and SI of the left adrenal vein during ACTH-s AVS was significantly higher in the AM-AVS group. Data were compared between the 2 groups using the Mann–Whitney U test; data are shown in a box-and-whisker diagram. R-AV, right adrenal vein; L-AV, left adrenal vein; SI, selectivity index; ACTH, adrenocorticotropic hormone; ACTH-s, ACTH-stimulated; AVS, adrenal venous sampling.

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  Figure 3.. Success rate of AVS in AM and PM. SI <2 during basal AVS and SI <5 during ACTH-s AVS were excluded as failure. In the AM-AVS group, the success rates were 81% (307/381 patients) for basal AVS and 92% (350/381 patients) for ACTH-s AVS, with an overall success rate of 76% (288/381 patients). In the PM-AVS group, the success rates were 74% (155/209 patients) for basal AVS and 88% (184/209 patients) for ACTH-s AVS, with an overall success rate was 70% (147/209 patients). There was no significant difference in the AVS success rates between the AM-AVS and PM-AVS groups. SI, selectivity index; ACTH, adrenocorticotropic hormone; ACTH-s, ACTH-stimulated; AVS, adrenal venous sampling.

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  Figure 4.. PAC in the inferior vena cava blood. The PAC of ACTH-s AVS was significantly higher than the PAC of basal AVS in both AM and PM groups. Regarding basal AVS, the PAC was significantly higher in the AM than in the PM. Data were compared between the 2 groups using the Mann–Whitney U test; data are shown in a box-and-whisker diagram. ACTH, adrenocorticotropic hormone; ACTH-s, ACTH-stimulated; AVS, adrenal venous sampling; PAC, plasma aldosterone concentration.

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  Figure 5.. Numbers of subtype diagnoses in AM (A) and PM (B) groups. Chi-squared tests were used. LI, lateralization index.

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  Figure 6.. PAC in the adrenal veins of patients diagnosed with unilateral PA. Of the patients with successful AVS before and after ACTH stimulation, those with LI >2 before loading and LI >4 after loading were classified as having unilateral PA. In both dominant-side adrenal venous blood and nondominant-side adrenal venous blood, PAC significantly increased with ACTH stimulation; however, there was no significant difference in the PAC of dominant-side adrenal venous blood and nondominant-side adrenal venous blood between the AM and PM groups for both basal AVS and ACTH-s AVS. Data were compared between the 2 groups using the Mann–Whitney U test; data are presented in a box-and-whisker diagram. ACTH, adrenocorticotropic hormone; ACTH-s, ACTH-stimulated; AVS, adrenal venous sampling; PAC, plasma aldosterone concentration; PA, primary aldosteronism.

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  Figure 7.. PAC in adrenal venous blood in patients with bilateral PA. PAC significantly increased with ACTH stimulation in both AM and PM groups. Those with LI values <2 during basal AVS and LI values <4 during ACTH-s AVS were classified as having bilateral lesions, respectively. PAC in adrenal venous blood was significantly higher in AM than in PM group for both basal AVS and ACTH-s AVS. Data were compared between the 2 groups using the Mann–Whitney U test; data are presented in a box-and-whisker diagram. AV, adrenal vein, ACTH, adrenocorticotropic hormone; ACTH-s, ACTH-stimulated; AVS, adrenal venous sampling; PAC, plasma aldosterone concentration.