Department of Endocrine and Metabolic Diseases, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Vascular Surgery, The Second Affiliated Hospital School of Medicine, Zhejiang University School of Medicine, Hangzhou, China.
Front Endocrinol (Lausanne). 2022 Feb 9;13:797021. doi: 10.3389/fendo.2022.797021. eCollection 2022.
We reviewed clinical research investigating the applications of adrenal vein sampling (AVS). AVS could be applied not only to primary aldosteronism (PA) but also to other endocrine diseases, such as adrenocorticotropic hormone (ACTH) independent Cushing syndrome (AICS) and hyperandrogenemia (HA). However, the AVS protocol requires improvements to increase its success rate. Using the computed tomography image fusion, coaxial guidewire technique, and fast intraprocedural cortisol testing (CCF) technique could improve the success rate of catheterization in AVS for PA. ACTH loading could be considered in medical centers with a low selectivity of AVS for PA but is not essential in those with mature AVS technology. The continuous infusion method should be recommended for ACTH stimulation in AVS for PA to reduce adverse events. AVS has not been routinely recommended before management decisions in AICS, but several studies verified that AVS was useful in finding out the source of excess cortisol, especially for distinguishing unilateral from bilateral disease. However, it is necessary to reassess the results of AVS in AICS with the use of reference hormones to fully normalize cortisol levels. In addition, it is essential to determine the optimal model that combines AVS results and mass size to guide the selection of surgical plans, including identifying the dominant gland and presenting the option of staged adrenalectomy, to minimize the impact of bilateral resection. For HA, AVS combined with ovarian intravenous sampling to locate excess androgens could be considered when imaging results are equivocal.
我们回顾了有关肾上腺静脉采样（AVS）应用的临床研究。AVS 不仅可应用于原发性醛固酮增多症（PA），还可应用于其他内分泌疾病，如促肾上腺皮质激素（ACTH）非依赖性库欣综合征（AICS）和高雄激素血症（HA）。然而，AVS 方案需要改进以提高成功率。使用计算机断层扫描图像融合、同轴导丝技术和快速术中皮质醇检测（CCF）技术可提高 PA 患者 AVS 导管插入术的成功率。在 AVS 对 PA 选择性较低的医疗中心可以考虑进行 ACTH 负荷试验，但在 AVS 技术成熟的中心则并非必要。应推荐在 PA 的 AVS 中使用持续输注方法进行 ACTH 刺激，以减少不良事件。在 AICS 做出管理决策之前，通常不建议进行 AVS，但有几项研究证实 AVS 有助于找出皮质醇过多的来源，尤其是用于区分单侧和双侧疾病。然而，有必要使用参考激素重新评估 AICS 中 AVS 的结果，以充分使皮质醇水平正常化。此外，确定将 AVS 结果与质量大小相结合的最佳模型以指导手术计划的选择至关重要，包括确定优势腺体并提供分期肾上腺切除术的选择，以尽量减少双侧切除的影响。对于 HA，当影像学结果不确定时，可以考虑将 AVS 与卵巢静脉采样相结合以定位雄激素过多。
