Adrenal venous sampling with adrenocorticotropic hormone stimulation: A meta‐analysis

2021 ◽  
Author(s):  
Junfeng Yang ◽  
Yanhong Yu ◽  
Zhuorui Zhang ◽  
Yuerong Wu ◽  
Zhengyu He
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Meta Analysis ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Hormone Stimulation

scholarly journals Adrenal Venous Sampling With or Without Adrenocorticotropic Hormone Stimulation: A Meta-Analysis

2018 ◽  
Vol 104 (4) ◽  
pp. 1060-1068 ◽  
Author(s):  
Irakoze Laurent ◽  
Manirakiza Astère ◽  
Fengfan Zheng ◽  
Xiangjun Chen ◽  
Jun Yang ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Web Of Science ◽  
Meta Analysis ◽  
Adrenal Vein ◽  
Adrenal Venous Sampling ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Venous Sampling ◽  
Acth Stimulation ◽  
The Cochrane Library

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. Design The Cochrane Library, PubMed, Embase, and Web of Science databases were searched to identify relevant articles. All cohort studies comparing the two techniques (AVS with ACTH stimulation and AVS without ACTH stimulation in a 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% 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.

Impact of adrenocorticotropic hormone stimulation during adrenal venous sampling on outcomes of primary aldosteronism

2019 ◽  
Vol 37 (5) ◽  
pp. 1077-1082 ◽  
Author(s):  
Yoshiyu Takeda ◽  
Hironobu Umakoshi ◽  
Yoshimichi Takeda ◽  
Takashi Yoneda ◽  
Isao Kurihara ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenocorticotropic Hormone ◽  
Adrenal Venous Sampling ◽  
Venous Sampling ◽  
Hormone Stimulation

Differential Diagnosis of Adrenocorticotropic Hormone-Independent Cushing Syndrome: Role of Adrenal Venous Sampling

2012 ◽  
Vol 18 (6) ◽  
pp. e153-e157 ◽  
Author(s):  
Raquel Martins ◽  
Reshma Agrawal ◽  
Daniel Berney ◽  
Rodney Reznek ◽  
Matthew Matson ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Adrenocorticotropic Hormone ◽  
Cushing Syndrome ◽  
Adrenal Venous Sampling ◽  
Venous Sampling

scholarly journals Combined Ovarian and Adrenal Venous Sampling in the Localization of Adrenocorticotropic Hormone-Independent Ectopic Cushing Syndrome

2017 ◽  
Vol 103 (3) ◽  
pp. 803-808
Author(s):  
Shi Chen ◽  
Ran Li ◽  
Xiaobo Zhang ◽  
Lin Lu ◽  
Ji Li ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Clinical Decision Making ◽  
Cushing Syndrome ◽  
Somatostatin Receptor ◽  
Clinical Decision ◽  
Adrenal Venous Sampling ◽  
Ovarian Vein ◽  
Venous Sampling ◽  
Pelvic Ultrasonography ◽  
The Right

Abstract Context Cushing syndrome is rarely caused by the secretion of cortisol from ovarian tumors. In clinical decision-making, it is important to determine whether the ovarian tumor is capable of secreting cortisol. Selective ovarian and adrenal venous sampling is scarcely reported in the localization of ACTH-independent ectopic Cushing syndrome. Case Description We present a case of 40-year-old Chinese woman who had weight gain, hirsutism, hypertension, and menstrual disorder over 6 months. Her physical examination and biochemical assessment revealed adrenocorticotropic hormone-independent Cushing syndrome. Adrenal computed tomography scan indicated no abnormality. A mass of 5.7 cm × 4.2 cm × 3.4 cm was discovered by pelvic ultrasonography. Somatostatin receptor scintigraphy revealed no abnormal radioactivity intake. Combined ovarian and adrenal venous sampling together with a cortisol assay were conducted. Results revealed cortisol concentration of the right-side ovarian vein, left-side ovarian vein, and peripheral vein of 268.60, 29.00, and 35.18 μg/dL, respectively, suggesting a right-side ovarian origin. A right-side salpingo-oophorectomy was performed and the pathological diagnosis revealed ovarian steroid cell tumor, not otherwise specified. The cortisol level was substantially lower after the patient underwent surgery and symptoms of Cushing syndrome disappeared. At 3-year follow-up, the patient remained disease free, and no tumor was observed on pelvic ultrasonogram. Conclusion Combined ovarian and adrenal venous sampling is valuable in the localization of adrenocorticotropic hormone–independent ectopic Cushing syndrome.

scholarly journals Adrenocorticotropic Hormone–Stimulated Adrenal Venous Sampling Underestimates Surgically Curable Primary Aldosteronism: A Retrospective Cohort Study and Review of Contemporary Studies

Hypertension ◽  
2021 ◽  
Author(s):  
Nicholas Yozamp ◽  
Gregory L. Hundemer ◽  
Marwan Moussa ◽  
Jonathan Underhill ◽  
Tali Fudim ◽  
...  
Keyword(s):  
Primary Aldosteronism ◽  
Adrenocorticotropic Hormone ◽  
Adrenal Venous Sampling ◽  
Original Research ◽  
Venous Sampling ◽  
Acth Stimulation ◽  
The Past ◽  
Unilateral Disease ◽  
The Impact ◽  
Lateralization Index

Guidelines recommend adrenal venous sampling to determine disease laterality in primary aldosteronism. Adrenocorticotropic hormone (ACTH) stimulation clearly improves the likelihood of successful adrenal vein catheterization but may lead to a decrease in lateralization rates. To examine the impact of ACTH on lateralization, we performed a retrospective analysis of 340 patients with confirmed primary aldosteronism who underwent adrenal venous sampling with a single interventional radiology team using a protocol of sampling both before and after an ACTH bolus. In addition to this original research, we conducted a review of similar studies from the past 5 years to develop a consensus on the impact of ACTH on lateralization for primary aldosteronism. In the original research analysis, following a bolus of ACTH, 58% of patients had a decline in lateralization index which led to discordance between the pre-ACTH and post-ACTH classifications of lateralization in up to 26% of cases. The majority of discordant cases were due to reclassification from unilateral disease pre-ACTH to bilateral disease post-ACTH. In patients who already lateralized with unstimulated sampling, the response to ACTH did not have any impact on surgical outcomes. In a review of contemporary studies, we identified 11 similar studies in the past 5 years, of which 10 reported either no change or a decrease in lateralization index following ACTH, resulting in ≈25% discordance between unstimulated and stimulated lateralization rates. We conclude that ACTH stimulation during adrenal venous sampling can underestimate surgically remediable primary aldosteronism and recommend that the role of ACTH be limited primarily to enhancing selectivity.

scholarly journals The Value of Adrenal Androgens for Correcting Cortisol Lateralization in Adrenal Venous Sampling in Patients with Normal Cortisol Secretion

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Wenjing Zhang ◽  
Keying Zhu ◽  
Hongyun Li ◽  
Yan Zhang ◽  
Dalong Zhu ◽  
...  
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Adrenal Venous Sampling ◽  
Cortisol Secretion ◽  
Venous Sampling ◽  
Adrenal Androgens ◽  
Wide Range ◽  
Adrenal Masses ◽  
The Mean ◽  
Positive Correlations ◽  
The Right

The management of patients with adrenocorticotropic hormone-independent Cushing’s syndrome and bilateral adrenal masses is challenging. Adrenal venous sampling (AVS) has been used to identify functional lesions in previous studies, but it is not always reliable. The present study aims to address the variability of cortisol in the adrenal veins of patients without excessive cortisol secretion and investigate the use of adrenal androgens to correct the cortisol lateralization ratio in AVS. Thirty-seven patients with primary aldosteronism underwent successful AVS. Patients with normal cortisol secretion exhibited a wide range of cortisol concentrations in the right (601-89, 400 nmol/l) and left (331-35, 300 nmol/l) adrenal veins. The median cortisol gradients between adrenal venous and peripheral venous samples were 15.25 and 10.14 in the right and left sides, respectively, and the cortisol lateralization ratio (high side to low side) was as high as 9.49 (median 1.54). The mean plasma levels of cortisol in the adrenal venous and peripheral venous samples decreased from t-15 to t0. Significant positive correlations were observed between the cortisol concentrations and both androstenedione and dehydroepiandrosterone concentrations in the right and left adrenal veins. After correcting for androstenedione or dehydroepiandrosterone levels, the cortisol lateralization ratio was less than 2 in most adrenal venous samples. The present study demonstrated the wide variation in cortisol concentrations in the adrenal veins of patients with normal cortisol secretion. The adrenal androgens might be ideal analytes used as normalizers when assessing the cortisol lateralization of AVS in normal or hypercortisolism cases.

scholarly journals Adrenal venous sampling in a patient with adrenal Cushing syndrome

2015 ◽  
pp. 84-87 ◽  
Author(s):  
Carlos Esteban Builes Montaño ◽  
Carlos Andres Villa Franco ◽  
Alejandro Román Gonzalez ◽  
Alejandro Vélez Hoyos ◽  
Santiago Echeverri Isaza
Keyword(s):  
Therapeutic Approach ◽  
Adrenocorticotropic Hormone ◽  
Cushing Syndrome ◽  
Primary Hyperaldosteronism ◽  
Adrenal Venous Sampling ◽  
Adrenal Hyperplasia ◽  
Venous Sampling

The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.

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