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
Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa 920-8641, Japan.
Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan.
J Endocr Soc. 2022 Jul 26;6(9):bvac104. doi: 10.1210/jendso/bvac104. eCollection 2022 Sep 1.
Adrenocorticotropin (ACTH) loading is used to increase the success rate of adrenal vein sampling (AVS).
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.
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.
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.
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.
促肾上腺皮质激素（ACTH）负荷试验用于提高肾上腺静脉采血（AVS）的成功率。
由于缺乏关于这一主题的可靠数据，我们旨在确定术中皮质醇测量（ICM）对ACTH刺激的AVS（AS-AVS）的影响。
这项多中心、回顾性、观察性研究在日本的28个三级中心进行。在纳入的4057例患者中，2396例接受了基础AVS（B-AVS）和AS-AVS，并根据是否使用ICM分为两组。测量ICM对AS-AVS的影响。
在接受两种AVS手术的患者中，ICM组的B-AVS和AS-AVS成功率均显著高于非ICM组。然而，两组中B-AVS成功后AS-AVS失败的概率以及B-AVS失败后AS-AVS成功的概率并无显著差异。对于亚型诊断，倾向评分匹配显示两组之间无显著差异，B-AVS和AS-AVS在亚型诊断方面的差异率也无显著差异。
在进行两种AVS手术的方案中，ICM显著提高了B-AVS和AS-AVS的成功率，且对亚型诊断无影响。然而，在进行两种AVS手术的方案中，结果表明，如果仅在进行B-AVS时使用ICM，那么在进行AS-AVS时可能不需要ICM。我们的研究表明，AVS期间的ICM起着重要作用，应予以推荐。
