Hyperaldosteronism: Sampling the adrenal veins
Hyperaldosteronism: Sampling the adrenal veins
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DOI：
10.1148/radiology.198.2.8596821
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发表时间：
1996-02-01
期刊：
影响因子：
19.7
通讯作者：
Gill, JR
中科院分区：
文献类型：
--
作者：
Doppman, JL;Gill, JR
MOST内分泌学家一致认为，鉴别单侧和双侧肾上腺增生症的最可靠的检测方法是双侧肾上腺静脉采样(1-5)。各种功能研究(例如，与姿势变化相关的I8-羟基皮质酮水平测试和血浆醛固酮水平变化)都有70%-80%的敏感性。肾上腺皮质结节大于7 mm可通过薄层、横断面成像(如CT和磁共振成像)发现，但肾上腺小结节是40~60岁(6~8岁)高血压患者常见的偶发表现，可能混淆腺瘤和增生症的鉴别诊断。也有几个罕见的原因导致醛固酮增多症(9)和令人困惑的横断面影像表现，例如单侧原发性肾上腺增生(10)。患有这些形式的醛固酮增多症的患者可以从肾上腺切除术中受益，但需要进行静脉采样。尽管肾上腺静脉采样具有公认的敏感性，但内分泌学家很少要求进行这一程序，除非所有其他研究的结果不明确或不具诊断性。放弃一项程序的理由是
M OST endocrinologists agree that the most reliable test for distinguishing unilateral aldosteronoma from bilateral hyperplasia is bilateral adrenal venous sampling(1-5). The various functional studies (eg, tests of i8-hydroxycorticosterone levels and changes in plasma levels of aldosterone associated with postural changes) all have sensitivities of 70%-80%. Adrenocortical nodules larger than 7 mm can be detected with thin-section, cross-sectional imaging(eg, computed tomography[CT] and magnetic resonance imaging); however, small adrenal nodules are common incidental findings in hypertensive patients aged 40-60 years (6-8) and may confuse the differential diagnosis of adenoma versus hyperplasia. There are also several rare causes of hyperaldosteronism(9) with confusing findings of cross-sectional imaging, such as unilateral primary adrenal hyperplasia(10). Patients with these forms of hyperaldosteronism may benefit from adrenalectomy but require performance of venous sampling. In spite of the acknowledged sensi-fivity of adrenal venous sampling, endocrinologists rarely request this procedure unless findings of all other studies are ambiguous or nondiagnostic. The rea-son for abandoning a procedure with