Discussion
In this RCT, we found that the treatment decision based on AVS with or without ACTH stimulation did not result in clinically significant differences in patient outcomes. Currently, there is marked variation in the conduct of AVS across different centers worldwide. The use of ACTH stimulation during AVS has generated much discussion, but there is no consensus on its use. The findings of this study offer valuable insights into the value of ACTH stimulation during AVS.The key finding of our study is that a similar proportion of surgically treated patients achieved complete biochemical success, irrespective of ACTH use during their AVS. Previous studies have mostly reported a decrease in the median LI following ACTH stimulation when compared with the LI prior to ACTH.Our finding that clinical outcomes were not different between ACTH-stimulated and non–ACTH-stimulated groups is different than in previous reports.The finding that ACTH stimulation during AVS increased the selectivity index in bilateral adrenal veins is consistent with previous reports.