학술논문
Effect of Intraprocedural Cortisol Measurement on ACTH-stimulated Adrenal Vein Sampling in Primary Aldosteronism
Clinical Research Article
Clinical Research Article
Document Type
Academic Journal
Author
Kometani, Mitsuhiro; Yoneda, Takashi; Karashima, Shigehiro; Takeda, Yoshiyu; Tsuiki, Mika; Yasoda, Akihiro; Kurihara, Isao; Wada, Norio; Katabami, Takuyuki; Sone, Masakatsu; Ichijo, Takamasa; Tamura, Kouichi; Ogawa, Yoshihiro; Kobayashi, Hiroki; Okamura, Shintaro; Inagaki, Nobuya; Kawashima, Junji; Fujita, Megumi; Oki, Kenji; Matsuda, Yuichi; Tanabe, Akiyo; Naruse, Mitsuhide
Source
Journal of the Endocrine Society. September 2022, Vol. 6 Issue 9
Subject
Language
English
ISSN
2472-1972
Abstract
Primary aldosteronism (PA) is the most common cause of secondary endocrine hypertension [1]. Patients with PA are at a higher risk of developing cardiovascular disease than those with essential hypertension [...]
Context: Adrenocorticotropin (ACTH) loading is used to increase the success rate of adrenal vein sampling (AVS). Objective: We aimed to determine the effect of intraprocedural cortisol measurement (ICM) on ACTH-stimulated AVS (AS- AVS) owing to a lack of reliable data on this topic. Methods: This multicenter, retrospective, observational study took place in 28 tertiary centers in Japan. Among 4057 patients enrolled, 2396 received both basal AVS (B-AVS) and AS-AVS and were divided into 2 groups according to whether ICM was used. The effect of ICM on AS-AVS was measured. Results: In patients who underwent both AVS procedures, the ICM group had significantly higher success rates for both B-AVS and AS-AVS than the non-ICM group did. However, the probability of failure of AS-AVS after a successful B-AVS and the probability of success of AS-AVS after a failed B-AVS were not significantly different in the 2 groups. For subtype diagnosis, propensity-score matching revealed no significant difference between the 2 groups, and the discrepancy rate between B-AVS and AS-AVS for subtype diagnosis was also not significantly different. Conclusion: ICM significantly increased the success rate of B-AVS and AS-AVS in protocols in which both AVS procedures were performed and had no effect on subtype diagnosis. However, in protocols in which both AVS procedures were performed, the results suggest ICM may not be necessary when performing AS-AVS if ICM is used only when B-AVS is performed. Our study suggests that ICM during AVS plays an important role and should be recommended. Key Words: primary aldosteronism, adrenal vein sampling, intraprocedural cortisol measurement Abbreviations: ACTH, adrenocorticotropin; ARR, aldosterone-to-renin ratio; AS-AVS, adrenocorticotropin-stimulated adrenal vein sampling; AVS, adrenal vein sampling; B-AVS, basal adrenal vein sampling; BMI, body mass index; ECLIA, electrochemiluminescence immunoassay; GN- ICA, immunochromatographic assay based on gold nanoparticles; ICM, intraprocedural cortisol measurement; LR, lateralization ratio; JRAS, Japan Rare/Intractable Adrenal Diseases Study; PA, primary aldosteronism; PAC, plasma aldosterone concentration; POCT, point-of-care testing; SI, selectivity index.
Context: Adrenocorticotropin (ACTH) loading is used to increase the success rate of adrenal vein sampling (AVS). Objective: We aimed to determine the effect of intraprocedural cortisol measurement (ICM) on ACTH-stimulated AVS (AS- AVS) owing to a lack of reliable data on this topic. Methods: This multicenter, retrospective, observational study took place in 28 tertiary centers in Japan. Among 4057 patients enrolled, 2396 received both basal AVS (B-AVS) and AS-AVS and were divided into 2 groups according to whether ICM was used. The effect of ICM on AS-AVS was measured. Results: In patients who underwent both AVS procedures, the ICM group had significantly higher success rates for both B-AVS and AS-AVS than the non-ICM group did. However, the probability of failure of AS-AVS after a successful B-AVS and the probability of success of AS-AVS after a failed B-AVS were not significantly different in the 2 groups. For subtype diagnosis, propensity-score matching revealed no significant difference between the 2 groups, and the discrepancy rate between B-AVS and AS-AVS for subtype diagnosis was also not significantly different. Conclusion: ICM significantly increased the success rate of B-AVS and AS-AVS in protocols in which both AVS procedures were performed and had no effect on subtype diagnosis. However, in protocols in which both AVS procedures were performed, the results suggest ICM may not be necessary when performing AS-AVS if ICM is used only when B-AVS is performed. Our study suggests that ICM during AVS plays an important role and should be recommended. Key Words: primary aldosteronism, adrenal vein sampling, intraprocedural cortisol measurement Abbreviations: ACTH, adrenocorticotropin; ARR, aldosterone-to-renin ratio; AS-AVS, adrenocorticotropin-stimulated adrenal vein sampling; AVS, adrenal vein sampling; B-AVS, basal adrenal vein sampling; BMI, body mass index; ECLIA, electrochemiluminescence immunoassay; GN- ICA, immunochromatographic assay based on gold nanoparticles; ICM, intraprocedural cortisol measurement; LR, lateralization ratio; JRAS, Japan Rare/Intractable Adrenal Diseases Study; PA, primary aldosteronism; PAC, plasma aldosterone concentration; POCT, point-of-care testing; SI, selectivity index.