Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism.
Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism.
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肾上腺计算机断层扫描在预测原发性醛固酮增多症中低钾血症和醛固酮升高的年轻患者单侧亚型方面的准确性。
DOI：
10.1111/cen.13582
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发表时间：
2018
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et al.
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作者：
Umakoshi;H.;Ogasawara;T.;Takeda;Y.;Kurihara;I.;Itoh;H.;Katabami;T.;Ichijo;T.;Wada;N.;Shibayama;Y.;Yoshimoto;T.;et al.
目前的内分泌学会指南建议年龄<35岁的原发性醛固酮增多症（PA）和单侧肾上腺计算机断层扫描（CT）病变的患者在进行单侧肾上腺切除术之前可能不需要肾上腺静脉采样（AVS）。然而，这一建议仅基于文献中一份报告的数据。目的探讨单侧肾上腺疾病伴低钾血症和醛固酮升高的年轻PA患者CT表现的准确性。设计和患者我们回顾性研究了358例PA患者（n = 30，年龄<35岁；n = 39，年龄35 - 40岁；n = 289，年龄≥40岁），均伴有低钾血症和醛固酮升高，CT显示单侧病变，均成功行AVS。主要结果测量：年龄<35岁患者的AVS表现和/或手术结果决定了CT表现的准确性。结果年龄<35岁的患者CT与AVS诊断符合率为90%(27/30)，35 ~ 40岁的患者为79%(31/39)，≥40岁的患者为69%(198/289)（趋势p < 0.01）。三名年龄<35岁的患者和三名年龄在35 - 40岁之间的患者证实了手术的益处，这些患者的CT和AVS结果不一致。总体而言，年龄<35岁的CT诊断准确率为100%(30/30)，35 - 40岁的CT诊断准确率为87%（34/39）。结论原发性醛固酮增多症患者年龄<35岁，伴有低血钾、醛固酮升高及肾上腺CT单侧病变，可避免AVS。
ContextThe current Endocrine Society Guideline suggests that patients aged <35 years with marked primary aldosteronism (PA) and unilateral adrenal lesions on adrenal computed tomography (CT) scan may not need adrenal vein sampling (AVS) before proceeding to unilateral adrenalectomy. This suggestion is, however, based on the data from only one report in the literature.ObjectiveWe sought to determine the accuracy of CT findings in young PA patients who had unilateral adrenal disease on CT with hypokalaemia and elevation of aldosterone.Design and patientsWe retrospectively studied 358 PA patients (n = 30, aged <35 years; n = 39, aged 35‐40 years; n = 289, aged ≥40 years) with hypokalaemia and elevation of aldosterone and unilateral disease on CT who had successful AVS.Main outcome measureAccuracy of CT findings is determined by AVS findings and/or surgical outcomes in patients aged <35 years.ResultsConcordance of the diagnosis between CT and AVS was 90% (27/30) in patients aged <35 years, 79% (31/39) in patients aged 35‐40 years and 69% (198/289) in those aged ≥40 years (trend forP< .01). Surgical benefit was confirmed in three patients aged <35 years and in three patients aged 35‐40 years with the available surgical data who had discordance between CT and AVS findings. Collectively, the diagnostic accuracy of CT findings was 100% (30/30) if aged <35 years and 87% (34/39) if aged 35‐40 years.ConclusionPrimary aldosteronism patients aged <35 years with hypokalaemia and elevation of aldosterone and unilateral disease on adrenal CT could be spared AVS.