Two Atypical Cases of Adrenal Primary Aldosteronism Underwent ACTH Loaded Adrenal Venous Sampling(Significance of ACTH-loaded adrenal venous sampling in adrenal primary aldosteronism,Proceedings of the 2nd Conference on Adrenal Venous Sampling)

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