Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism
Clinical Management and Outcomes of Adrenal Hemorrhage Following Adrenal Vein Sampling in Primary Aldosteronism
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DOI：
10.1161/hypertensionaha.115.06305
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发表时间：
2016-01-01
期刊：
影响因子：
8.3
通讯作者：
Mulatero, Paolo
中科院分区：
文献类型：
--
作者：
Monticone, Silvia;Satoh, Fumitoshi;Mulatero, Paolo
醛固酮腺瘤和双侧肾上腺增生占原发性醛固酮增多症的90%以上。区分双侧和单侧疾病具有根本重要性，因为它允许靶向治疗。肾上腺静脉取样（AVS）是术前区分单侧和双侧亚型的唯一可靠方法。AVS的一种罕见但严重的并发症是肾上腺出血（AH）。我们回顾性地详细检查了24例在6个不同的转诊高血压中心的AVS期间发生的AH。AH更常累及右侧肾上腺（n=18）而非左侧（n=5，P <10岁），且经验较少的放射科医生。在9例发生在醛固酮腺瘤对侧腺体的AH并接受完全（n=6）或部分（n=3）单侧肾上腺切除术的患者中，仅1例需要长期皮质类固醇替代治疗肾上腺功能不全。在发生醛固酮腺瘤同侧腺体AH（n=6）或双侧肾上腺增生（n=9）的患者中，未发生血压降低或原发性醛固酮增多症生化消退。没有患者需要侵入性治疗来控制出血或输血。总之，AH通常有一个积极的结果，对肾上腺功能没有影响或影响很小，AVS应该仍然是原发性醛固酮增多症亚型分化的最佳方法。
Aldosterone-producing adenoma and bilateral adrenal hyperplasia account for >90% of all primary aldosteronism cases. Distinguishing between bilateral and unilateral disease is of fundamental importance because it allows targeted therapy. Adrenal vein sampling (AVS) is the only reliable means to preoperatively differentiate between unilateral and bilateral subtypes. A rare but serious complication of AVS is an adrenal hemorrhage (AH). We retrospectively examined in detail 24 cases of AH during AVS in 6 different referral hypertension centers. AH more often affected the right adrenal (n=18) than the left (n=5, P10 years) and less experienced radiologists. Of 9 patients who suffered AH in the gland contralateral to an aldosterone-producing adenoma and who underwent complete (n=6) or partial (n=3) unilateral adrenalectomy, only one required long-term corticosteroid replacement for adrenal insufficiency. No reduction in blood pressure or biochemical resolution of primary aldosteronism occurred in any of those patients who experienced AH in the gland ipsilateral to an aldosterone-producing adenoma (n=6) or who had bilateral adrenal hyperplasia (n=9). No patient required invasive treatments to control bleeding or blood transfusion. In conclusion, AH usually has a positive outcome causing either no or minor effects on adrenal function, and AVS should remain the best approach to primary aldosteronism subtype differentiation.