Localization of aldosterone-producing adrenocortical adenomas: Significance of adrenal venous sampling
Localization of aldosterone-producing adrenocortical adenomas: Significance of adrenal venous sampling
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DOI：
10.1291/hypres.30.1083
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发表时间：
2007-11-01
影响因子：
5.4
通讯作者：
Ito, Sadayoshi
中科院分区：
文献类型：
--
作者：
Satoh, Fumitoshi;Abe, Takaaki;Ito, Sadayoshi
产醛固酮腺瘤(APA)的准确定位是治疗原发性醛固酮增多症(PA)的关键。为证实肾上腺静脉采血(AVS)的临床应用价值，我们对87例行AVS的PA患者进行了回顾性研究。在肾上腺皮质激素(ACTH)刺激前和刺激后同时采集左右肾上腺静脉流出物，以测量醛固酮浓度(A)和皮质醇浓度(C)。根据AVS结果，我们判断66例为单侧醛固酮高分泌，其余21例为无明显偏侧。在上述66名受试者中，61名接受了经腹膜后入路的腹腔镜肾上腺摘除手术。所有病例均经组织病理学证实APA的存在，随着血浆醛固酮浓度(PAC)的正常化，血压显著降低。受试者操作员特征(ROC)曲线分析表明，ACTH刺激后高、低侧A/C的比值(A/C)是一项有用的指标，其临界值为2.6，敏感性为0.98，特异性为1.0。手术患者对侧与对侧APA的ROC曲线分析显示，A的临界值为1,340 ng/dL，敏感性为0.92，特异性为1.00。我们的结果表明同时刺激AVS和ACTH对APA的定位是有用的。
Accurate localization of aldosterone-producing adenoma (APA) is essential for the treatment of primary aldosteronism (PA). In order to confirm the clinical usefulness of adrenal venous sampling (AVS), we retrospectively studied 87 cases of PA in whom AVS was conducted. We collected right and left adrenal venous effluents simultaneously before and after adrenocorticotropic hormone (ACTH) stimulation for measurements of aldosterone concentration (A) and cortisol concentration (C). Based on AVS results, we judged 66 cases as having unilateral aldosterone hypersecretion and the remaining 21 cases as having no apparent laterality. Of the above 66 subjects, 61 underwent laparoscopic removal of the adrenal gland through a retroperitoneal approach. The presence of APA was histopathologically confirmed, and blood pressure decreased significantly with normalization of plasma aldosterone concentration (PAC) in all cases. The receiver operator characteristics (ROC) curve analysis between the operated and no-apparent-laterality groups revealed that the ratio of A/C on the higher side to A/C on the lower side (A/C ratio) after ACTH stimulation is a useful index, with a cutoff value of 2.6, a sensitivity of 0.98 and a specificity of 1.0. The ROC curve analysis between the APA side and contralateral side within the operated patients revealed that the cutoff value of A was 1,340 ng/dL, with a sensitivity of 0.92 and a specificity of 1.00. Our results indicate the usefulness of simultaneous AVS and ACTH stimulation for localizing APA.