Irakoze Laurent1,2, Manirakiza Astère3, Fengfan Zheng1, Xiangjun Chen1, Jun Yang4, Qingfeng Cheng1, Qifu Li1. 1. Department of Endocrinology, First Affiliated Hospital of Chongqing Medical University. 2. Kamenge military hospital, Ministry of Public Health and Fighting AIDS, Bujumbura, Burundi. 3. Department of Oncology, First Affiliated Hospital of Chongqing Medical University. 4. Cardiovascular Endocrinology Laboratory, Hudson Institute of Medical Research, Australia.
Abstract
CONTEXT: Adrenal venous sampling (AVS) with or without adrenocorticotropic hormone (ACTH) stimulation is the test of choice to identify patients with a surgically curable subtype of primary aldosteronism (PA). Whether AVS with ACTH stimulation is more effective than AVS without ACTH stimulation remains controversial. OBJECTIVE: To compare the effectiveness of AVS with ACTH stimulation and AVS without ACTH stimulation in patients with PA. METHODS: The Cochrane Library, PubMed, Embase, and Web of Science databases were searched to identify relevant articles. All cohort studies comparing the 2 techniques (AVS with ACTH stimulation and AVS without ACTH stimulation in patient with PA) were included in the analysis. RESULTS: A total of 14 studies met the inclusion criteria, and they were analyzed. AVS with ACTH stimulation did not significantly reduce the number of incorrect lateralization more than AVS without ACTH stimulation in patients with PA [OR: 0.76, 95% confidence interval (CI): 0.36, 1.59; P=0.47]. AVS with ACTH stimulation significantly reduced the number of unsuccessful cannulations of both adrenal veins more than AVS without ACTH stimulation in patients with PA (OR: 0.26, 95% CI: 0.17, 0.40; P<0.00001). For subgroup analyses, it also significantly reduced the number of unsuccessful cannulations of left adrenal vein and right adrenal vein (OR: 0.14, 95% CI: 0.06, 0.33; P<0.00001 and OR: 0.30, 95% CI: 0.12, 0.71; P=0.007, respectively). CONCLUSION: AVS with ACTH stimulation can significantly reduce the number of unsuccessful cannulations, without significantly reducing the number of incorrect lateralization. Further studies are still needed to verify these findings.
CONTEXT: Adrenal venous sampling (AVS) with or without adrenocorticotropic hormone (ACTH) stimulation is the test of choice to identify patients with a surgically curable subtype of primary aldosteronism (PA). Whether AVS with ACTH stimulation is more effective than AVS without ACTH stimulation remains controversial. OBJECTIVE: To compare the effectiveness of AVS with ACTH stimulation and AVS without ACTH stimulation in patients with PA. METHODS: The Cochrane Library, PubMed, Embase, and Web of Science databases were searched to identify relevant articles. All cohort studies comparing the 2 techniques (AVS with ACTH stimulation and AVS without ACTH stimulation in patient with PA) were included in the analysis. RESULTS: A total of 14 studies met the inclusion criteria, and they were analyzed. AVS with ACTH stimulation did not significantly reduce the number of incorrect lateralization more than AVS without ACTH stimulation in patients with PA [OR: 0.76, 95% confidence interval (CI): 0.36, 1.59; P=0.47]. AVS with ACTH stimulation significantly reduced the number of unsuccessful cannulations of both adrenal veins more than AVS without ACTH stimulation in patients with PA (OR: 0.26, 95% CI: 0.17, 0.40; P<0.00001). For subgroup analyses, it also significantly reduced the number of unsuccessful cannulations of left adrenal vein and right adrenal vein (OR: 0.14, 95% CI: 0.06, 0.33; P<0.00001 and OR: 0.30, 95% CI: 0.12, 0.71; P=0.007, respectively). CONCLUSION: AVS with ACTH stimulation can significantly reduce the number of unsuccessful cannulations, without significantly reducing the number of incorrect lateralization. Further studies are still needed to verify these findings.
Authors: Taweesak Wannachalee; Lili Zhao; Kazutaka Nanba; Aya T Nanba; James J Shields; William E Rainey; Richard J Auchus; Adina F Turcu Journal: J Clin Endocrinol Metab Date: 2019-12-01 Impact factor: 5.958
Authors: Nicholas Yozamp; Gregory L Hundemer; Marwan Moussa; Jonathan Underhill; Tali Fudim; Barry Sacks; Anand Vaidya Journal: Hypertension Date: 2021-05-17 Impact factor: 9.897