Corticotropin Stimulation in Adrenal Venous Sampling for Patients With Primary Aldosteronism

作者全名："Yang, Shumin; Du, Zhipeng; Zhang, Xizi; Zhen, Qianna; Shu, Xiaoyu; Yang, Jun; Song, Ying; Yang, Yi; Li, Qifu; Hu, Jinbo"

作者地址："[Yang, Shumin; Du, Zhipeng; Zhang, Xizi; Zhen, Qianna; Song, Ying; Yang, Yi; Li, Qifu; Hu, Jinbo] Chongqing Med Univ, Affiliated Hosp 1, Dept Endocrinol, Chongqing, Peoples R China; [Shu, Xiaoyu] Capital Med Univ, Beijing Chao Yang Hosp, Dept Endocrinol, Beijing, Peoples R China; [Yang, Jun] Monash Univ, Dept Med, Clayton, Vic, Australia; [Yang, Jun] Hudson Inst Med Res, Ctr Endocrinol & Metab, Clayton, Vic, Australia; [Li, Qifu; Hu, Jinbo] Chongqing Med Univ, Affiliated Hosp 1, 1 Youyi St, Chongqing 400016, Peoples R China"

通信作者："Li, QF; Hu, JB (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, 1 Youyi St, Chongqing 400016, Peoples R China."

来源：JAMA NETWORK OPEN

ESI学科分类：　

WOS号：WOS:001091985600003

JCR分区：Q1

影响因子：13.8

年份：2023

卷号：6

期号：10

开始页：　

结束页：　

文献类型：Article

关键词：　

摘要："ImportanceAdrenal venous sampling (AVS) is usually recommended to distinguish between unilateral and bilateral primary aldosteronism (PA) before definitive surgical or medical treatment is offered. Whether a treatment decision based on AVS with or without corticotropin (ACTH) stimulation leads to different biochemical and clinical remission rates in patients with PA remains unclear.ObjectiveTo evaluate whether treatment decisions based on AVS with or without ACTH stimulation lead to different biochemical and clinical remission rates in patients with PA.Design, Setting, and ParticipantsThis randomized clinical trial (RCT) was conducted at a tertiary hospital in China from July 8, 2020, to February 20, 2023, among patients with PA aged 18 to 70 years. Patients were followed up for 12 months after the initiation of treatment. An intention-to-diagnose analysis was conducted.InterventionsPatients were randomly assigned to undergo either ACTH-stimulated or non-ACTH-stimulated AVS.Main Outcomes and MeasuresThe primary end point was the proportion of patients with complete biochemical remission after 12 months of follow-up. Secondary outcomes included the proportion of patients who achieved complete clinical remission after 12 months of follow-up, dosages of antihypertensive agents, rate of successful bilateral AVS, and adverse events.ResultsOf 228 patients with PA, 115 were randomized to the non-ACTH-stimulated group (median age, 50.0 years [IQR, 41.0-57.0 years]; 70 males [60.9%]) and 113 to the ACTH-stimulated group (median age, 50.0 years [IQR, 43.5-56.5 years]; 63 males [55.8%]). A total of 68 patients (59.1%) underwent adrenalectomy in the non-ACTH group and 65 (57.5%) in the ACTH group. There was no significant difference in the proportion of patients with complete biochemical remission who were managed on the basis of AVS with vs without ACTH stimulation (with: 56 of 113 [49.6%]; without: 59 of 115 [51.3%]; P = .79). There also was no significant difference in the proportion of patients who achieved complete clinical remission between the non-ACTH and ACTH groups (26 of 115 [22.6%] and 31 of 113 [27.4%], respectively; P = .40). The intensity of therapy with antihypertensives, successful catheterization of bilateral adrenal veins, and incidence of adverse events did not significantly differ between the non-ACTH and ACTH groups.Conclusions and RelevanceIn this RCT, treatment of PA on the basis of non-ACTH-stimulated or ACTH-stimulated AVS did not lead to significant differences in clinical outcomes for the patients. These results suggest that ACTH stimulation during AVS may not have clinical benefit, at least in the Chinese population.Trial RegistrationClinicalTrials.gov Identifier: NCT04461535"

基金机构："National Natural Science Foundation of China [82100833, U21A20355]; Joint Medical Research Project of Chongqing Science and Technology Commission [2022ZDXM003]; Chongqing Health and Family Planning Commission; Major Project of Prevention and Treatment for Common Diseases grant from the National Key Research & Development Plan of China [2021YFC2501600, 2021YFC2501603]; National Key Research and Development Project [2022YFC2505300]"

基金资助正文："This work was supported by grants 82100833 and U21A20355 from the National NaturalScience Foundation of China; major project grant 2022ZDXM003 from the Joint Medical Research Project of Chongqing Science and Technology Commission and Chongqing Health and Family Planning Commission; Major Project of Prevention and Treatment for Common Diseases grant 2021YFC2501600 (subproject grant,2021YFC2501603) from the National Key Research & Development Plan of China; and grant 2022YFC2505300(subproject grant 2022YFC2505301) from The National Key Research and Development Project"