{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:42:36Z","timestamp":1782276156383,"version":"3.54.5"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,6,23]],"date-time":"2016-06-23T00:00:00Z","timestamp":1466640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Princess Alexandra Hospital Research Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Adrenal vein sampling (<jats:styled-content style=\"fixed-case\">AVS<\/jats:styled-content>) is used for determining treatment options for primary aldosteronism (<jats:styled-content style=\"fixed-case\">PA<\/jats:styled-content>), but is a difficult procedure. Adrenocorticotropic hormone (<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>) infusion or bolus has been reported to improve <jats:styled-content style=\"fixed-case\">AVS<\/jats:styled-content> success rates by increasing cortisol secretion, but effects on lateralization are controversial. We therefore assessed the effects of <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> in regard to <jats:styled-content style=\"fixed-case\">AVS<\/jats:styled-content> success and lateralization in our unit, after a change in protocol to <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>\u2010stimulated <jats:styled-content style=\"fixed-case\">AVS<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">AVS<\/jats:styled-content> was performed after overnight recumbency in patients with <jats:styled-content style=\"fixed-case\">PA<\/jats:styled-content> confirmed by fludrocortisone suppression testing. Bilateral sequential sampling was performed before and after an intravenous bolus of 250 mcg of <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>. Lateralization was defined as an aldosterone\/cortisol ratio in one adrenal vein at least twice peripheral, combined with a contralateral adrenal ratio no higher than peripheral (contralateral suppression).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 47 <jats:styled-content style=\"fixed-case\">AVS<\/jats:styled-content> procedures, the median adrenal\/peripheral cortisol gradient increased on the left (11\u00b76 <jats:italic>vs<\/jats:italic> 18\u00b72 \u03bcg\/100 ml, <jats:italic>P<\/jats:italic> &lt; 0\u00b7001) and right (15\u00b76 <jats:italic>vs<\/jats:italic> 31\u00b75 \u03bcg\/100 ml, <jats:italic>P<\/jats:italic> &lt; 0\u00b7001) after <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content>. A total of 34 of 47 studies were diagnostic pre\u2010<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> (six failing because of low aldosterone levels bilaterally and seven failing to cannulate one or both sides) <jats:italic>vs<\/jats:italic> 44 of 47 (<jats:italic>P<\/jats:italic> = 0\u00b7011) studies diagnostic post\u2010<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> (failure to cannulate one or both sides in 3). Concordance between diagnostic studies pre\u2010 and post\u2010<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> was 91%, but two bilateral cases became unilateral after <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> and one unilateral case before <jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> was bilateral afterwards.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> improved cortisol gradients and aldosterone secretion, resulting in a reduction in the proportion of nondiagnostic studies. There was a low proportion of discordance between pre\u2010 and post\u2010<jats:styled-content style=\"fixed-case\">ACTH<\/jats:styled-content> diagnoses, the significance of which is unclear.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13110","type":"journal-article","created":{"date-parts":[[2016,5,24]],"date-time":"2016-05-24T10:39:51Z","timestamp":1464086391000},"page":"703-709","source":"Crossref","is-referenced-by-count":56,"title":["Does <scp>ACTH<\/scp> improve the diagnostic performance of adrenal vein sampling for subtyping primary aldosteronism?"],"prefix":"10.1111","volume":"85","author":[{"given":"Martin J.","family":"Wolley","sequence":"first","affiliation":[{"name":"Endocrine Hypertension Research Centre Greenslopes and Princess Alexandra Hospitals University of Queensland School of Medicine Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf H.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre Greenslopes and Princess Alexandra Hospitals University of Queensland School of Medicine Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard D.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre Greenslopes and Princess Alexandra Hospitals University of Queensland School of Medicine Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Stowasser","sequence":"additional","affiliation":[{"name":"Endocrine Hypertension Research Centre Greenslopes and Princess Alexandra Hospitals University of Queensland School of Medicine Brisbane Qld Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,6,23]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"1889","article-title":"The Management of Primary Aldosteronism: Case Detection, Diagnosis, and 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