Adrenal venous sampling with or without adrenocorticotropic hormone stimulation: A meta-analysis

Area of Science:

• Endocrinology
• Interventional Radiology
• Surgical Oncology

Background:

• Adrenal venous sampling (AVS) is crucial for diagnosing primary aldosteronism (PA).
• The use of adrenocorticotropic hormone (ACTH) stimulation during AVS is debated.
• Comparing AVS with and without ACTH stimulation is essential for optimizing PA diagnosis.

Purpose of the Study:

• To compare the diagnostic effectiveness of AVS with ACTH stimulation versus AVS without ACTH stimulation in patients with PA.
• To evaluate the impact of ACTH stimulation on lateralization accuracy and procedural success.

Main Methods:

• Systematic literature search of Cochrane Library, PubMed, Embase, and Web of Science.
• Inclusion of all cohort studies comparing AVS with ACTH stimulation and AVS without ACTH stimulation in PA patients.
• Meta-analysis of included studies to assess outcomes.

Main Results:

• AVS with ACTH stimulation did not significantly decrease incorrect lateralization compared to AVS without ACTH stimulation (OR: 0.76, P=0.47).
• AVS with ACTH stimulation significantly reduced unsuccessful cannulations of both adrenal veins (OR: 0.26, P<0.00001).
• Subgroup analyses confirmed reduced unsuccessful cannulations for both left (OR: 0.14, P<0.00001) and right (OR: 0.30, P=0.007) adrenal veins.

Conclusions:

• AVS with ACTH stimulation enhances procedural success by reducing cannulation failures.
• ACTH stimulation does not significantly improve the accuracy of lateralization in PA diagnosis.
• Further studies are warranted to validate these findings and guide clinical practice.