Effect of Intraprocedural Cortisol Measurement on ACTH-stimulated Adrenal Vein Sampling in Primary Aldosteronism

Mitsuhiro Kometani; Takashi Yoneda; Shigehiro Karashima; Yoshiyu Takeda; Mika Tsuiki; Akihiro Yasoda; Isao Kurihara; Norio Wada; Takuyuki Katabami; Masakatsu Sone; Takamasa Ichijo; Kouichi Tamura; Yoshihiro Ogawa; Hiroki Kobayashi; Shintaro Okamura; Nobuya Inagaki; Junji Kawashima; Megumi Fujita; Kenji Oki; Yuichi Matsuda; Akiyo Tanabe; Mitsuhide Naruse

doi:10.1210/jendso/bvac104

Effect of Intraprocedural Cortisol Measurement on ACTH-stimulated Adrenal Vein Sampling in Primary Aldosteronism

J Endocr Soc. 2022 Jul 26;6(9):bvac104. doi: 10.1210/jendso/bvac104. eCollection 2022 Sep 1.

Authors

Mitsuhiro Kometani¹, Takashi Yoneda¹, Shigehiro Karashima¹, Yoshiyu Takeda¹, Mika Tsuiki², Akihiro Yasoda², Isao Kurihara³, Norio Wada⁴, Takuyuki Katabami⁵, Masakatsu Sone⁶, Takamasa Ichijo⁷, Kouichi Tamura⁸, Yoshihiro Ogawa⁹, Hiroki Kobayashi¹⁰, Shintaro Okamura¹¹, Nobuya Inagaki¹², Junji Kawashima¹³, Megumi Fujita¹⁴, Kenji Oki¹⁵, Yuichi Matsuda¹⁶, Akiyo Tanabe¹⁷, Mitsuhide Naruse¹⁸

Affiliations

¹ Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa 920-8641, Japan.
² Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan.
³ Department of Endocrinology, Metabolism, and Nephrology, Keio University School of Medicine, Tokyo 160-8582, Japan.
⁴ Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo 060-8604, Japan.
⁵ Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama 241-0811, Japan.
⁶ Division of Metabolism and Endocrinology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511, Japan.
⁷ Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Tobu Hospital, Yokohama 230-8765, Japan.
⁸ Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan.
⁹ Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka 812-8582, Japan.
¹⁰ Division of Nephrology, Hypertension, and Endocrinology, Nihon University School of Medicine, Tokyo 173-8610, Japan.
¹¹ Department of Endocrinology, Tenri Hospital, Tenri 632-0015, Japan.
¹² Department of Diabetes, Endocrinology, and Nutrition, Kyoto University, Kyoto 606-8501, Japan.
¹³ Department of Metabolic Medicine, Faculty of Life Science, Kumamoto University, Kumamoto 860-8556, Japan.
¹⁴ Division of Nephrology and Endocrinology, University of Tokyo, Tokyo 113-0033, Japan.
¹⁵ Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan.
¹⁶ Department of Cardiology, Sanda City Hospital, Sanda 669-1321, Japan.
¹⁷ Division of Endocrinology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
¹⁸ Endocrine Center, Ijinkai Takeda General Hospital, Kyoto 601-1495, Japan.

Abstract

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.

Keywords: adrenal vein sampling; intraprocedural cortisol measurement; primary aldosteronism.