Adrenal venous sampling: cosyntropin stimulation or not?

Deinum, Jaap; Groenewoud, Hans; Wilt, Gert Jan van der; Lenzini, Livia; Rossi, Gian Paolo

doi:10.1530/eje-18-0844

Cited by 38 publications

(47 citation statements)

References 45 publications

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“…The use of ACTH in AVS remains controversial and has recently been reviewed by Deinum et al 20 An earlier review by Rossi et al 21 demonstrated increased cannulation success at the expense of reduced lateralization. In agreement with Rossi's review and a meta‐analysis, 11 our study also showed a decrease in lateralization indices between baseline and post‐ACTH at both centres (13% at Austin Health and 17% at Monash Health).…”

Section: Discussionmentioning

confidence: 99%

Utility of adrenocorticotropic hormone in adrenal vein sampling despite the occurrence of discordant lateralization

Chee

Abdul-Wahab

Libianto

et al. 2020

Clinical Endocrinology

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Background Adrenal vein sampling (AVS) is crucial for accurate lateralization of aldosterone excess but it is technically challenging due to the difficulty of adrenal vein cannulation. The use of adrenocorticotropic hormone (ACTH) to improve cannulation success is controversial and can lead to discordant lateralization outcomes. Objective To evaluate the utility of ACTH in two centres with different levels of AVS expertise and formulate a strategy for interpreting discordant results. Design A retrospective cross‐sectional analysis of AVS results and postoperative patient outcomes. Setting Two large tertiary hospitals with harmonized AVS protocols where adrenal venous samples are collected both before and after ACTH stimulation. Measurements Cannulation success (measured by selectivity index, SI), lateralization (measured by lateralization index, LI) and postoperative biochemical cure. Results Number of AVS procedures judged to have successful bilateral adrenal vein cannulation increased from 53% pre‐ to 73% post‐ACTH. The increase in cannulation success was significantly higher in centre where AVS was performed by multiple radiologists with a lower basal success rate. In both centres, the proportion of cases deemed to display lateralization significantly decreased with the use of ACTH (70% pre‐ to 52% post‐ACTH). Based on postoperative outcomes of patients with discordant results who underwent unilateral adrenalectomy, the combination of LI >3 pre‐ACTH and LI >2 post‐ACTH was predictive of a biochemical cure. Conclusion Adrenocorticotropic hormone can increase the rate of cannulation success during AVS at the expense of reduced lateralization. The criteria for lateralization should be carefully determined based on local data when ACTH is used.

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Section: Discussionmentioning

confidence: 99%

Utility of adrenocorticotropic hormone in adrenal vein sampling despite the occurrence of discordant lateralization

Chee

Abdul-Wahab

Libianto

et al. 2020

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…A recent meta-analysis showed that AVS with ACTH stimulation did not significantly reduce the number of incorrect lateralization but significantly reduced the number of unsuccessful cannulations compared with AVS without ACTH stimulation ( 57 ). However, the evidence is still limited and under debate which is beyond the scope of this review and can be found in prior review literature ( 58 ).…”

Section: Acth Stimulation Test For the Diagnosis Of Primary Aldosteromentioning

confidence: 99%

Cortisol Co-Secretion and Clinical Usefulness of ACTH Stimulation Test in Primary Aldosteronism: A Systematic Review and Biases in Epidemiological Studies

et al. 2021

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The hypothalamus-pituitary-adrenal (HPA) axis plays an important role in primary aldosteronism. Aldosterone biosynthesis is regulated not only by angiotensin II in the renin-angiotensin-aldosterone system, but also by adrenocorticotropic hormone (ACTH), one of the key components of the HPA axis. Although previous studies have reported cortisol cosecretion in primary aldosteronism, particularly aldosterone-producing adenoma (APA), the clinical relevance of such aldosterone and cortisol cosecretion from APA and hypertension or other metabolic disorders has not been fully established. Several somatic mutations including KCNJ5 and CACNA1D are known to induce autonomous production of aldosterone in APA, and the aldosterone responsiveness to ACTH may vary according to each mutation. The ACTH stimulation test has been reported to be a useful tool to distinguish the subtypes of primary aldosteronism (e.g., unilateral vs bilateral) in some studies, but it has not been commonly applied in clinical practice due to limited evidence. Given the recent advancement of imaging, omics research, and computational approach, it is important to summarize the most updated evidence to disentangle the potential impact of cortisol excess in primary aldosteronism and whether the ACTH stimulation test needs to be considered during the diagnostic process of primary aldosteronism. In this article, we conducted a systematic review of epidemiological studies about (i) cortisol cosecretion in primary aldosteronism and (ii) the ACTH stimulation test for the diagnosis of primary aldosteronism (including subtype diagnosis). Then, we discussed potential biases (e.g., confounding bias, overadjustment, information bias, selection bias, and sampling bias) in the previous studies and introduced some advanced epidemiological/statistical methods to minimize these limitations. A better understanding of biases and epidemiological perspective on this topic would allow us to produce further robust evidence and balanced discussion about the causal mechanisms involving the HPA axis and clinical usefulness of the ACTH stimulation test among patients with primary aldosteronism.

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“…Although AVS is accepted as the gold standard test for subtyping PA, the procedure is underused especially in underdeveloped areas partially because the AVS procedure is technically challenging and relatively expensive [9]. Due to the anatomical complexity and variations, AVS fails frequently even in experienced hands [10].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and effectiveness of a single-catheter approach for adrenal vein sampling in patients with primary aldosteronism

et al. 2021

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Background Adrenal vein sampling (AVS) is the preferred method for subtyping patients with primary aldosteronism, while the procedure is technically challenging. This study evaluated the feasibility and effectiveness of a single-catheter approach for AVS. Methods A retrospective analysis of 106 consecutive patients who underwent AVS was performed to determine the procedural success and complication rates. Bilateral AVS procedures were performed using a single 5-Fr Tiger catheter with repeated manual reshaping. Results We successfully advanced the catheter into the bilateral adrenal veins of all patients and reached a 90.6% procedural success rate of AVS. The procedural period was 33.0 ± 8.2 min, the fluoroscopy period was 5.8 ± 1.7 min, and the diagnostic contrast used was 17.3 ± 5.5 ml. Only one patient (0.9%) had a hematoma at the femoral puncture site. No other complications were observed. The operation period gradually shortened as the cumulative number of operations increased. The number of procedures required to overcome the learning curve was about 33 cases. Conclusions The single-catheter approach is feasible and effective for AVS. Moreover, this approach required a relatively short learning curve for an inexperienced trainee.

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Adrenal venous sampling: cosyntropin stimulation or not?

Cited by 38 publications

References 45 publications

Utility of adrenocorticotropic hormone in adrenal vein sampling despite the occurrence of discordant lateralization

Utility of adrenocorticotropic hormone in adrenal vein sampling despite the occurrence of discordant lateralization

Cortisol Co-Secretion and Clinical Usefulness of ACTH Stimulation Test in Primary Aldosteronism: A Systematic Review and Biases in Epidemiological Studies

Feasibility and effectiveness of a single-catheter approach for adrenal vein sampling in patients with primary aldosteronism

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