Diagnostic Accuracy of Computed Tomography in Predicting Primary Aldosteronism Subtype According to Age.
Diagnostic Accuracy of Computed Tomography in Predicting Primary Aldosteronism Subtype According to Age.
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根据年龄，计算机断层扫描预测原发性醛固酮亚型的诊断精度。
DOI：
10.3803/enm.2020.901
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Kim JH
中科院分区：
文献类型：
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作者：
Lee SH;Kim JW;Yoon HK;Koh JM;Shin CS;Kim SW;Kim JH
内分泌学会指南中关于35岁以下患有明显的原发性醛固酮增多症(PA)(低钾血症和血浆醛固酮浓度升高[PAC])和单侧CT病变的患者绕过肾上腺静脉采样(AVS)的指南是基于有限数量的研究。我们的目的是根据年龄确定PA患者CT检查的准确性。在这项回顾性研究中，我们调查了来自两个三级中心的466名PA患者的CT和AVS的一致性，这些患者成功地接受了AVS。CT诊断总准确率为64.4%(300/466)。在单侧病变组中，低钾血症患者的符合率高于无低钾血症患者(85.0%vs.43.6%，P<；0.001)。在PA明显(低钾血症和PAC>为15.9 ng/dL)和单侧病变组中，35岁组CT诊断准确率为84.6%(11/13)，35~39岁组为100.0%(20/20)，40~49岁组为89.4%(59/66)，≥组为79.8%(79/99)。整合的截止年龄和PAC分别为50岁和29.6 ng/dL。50岁年龄组与≥50岁年龄组的CT诊断准确率差异有统计学意义(90.9%vs.79.8%，P=0.044)；30.0 ng/dL患者中有139例(91.9%vs.87.7%，P=0.590)。低钾血症、PAC和GT；30.0 ng/dL、单侧病变的患者，无论年龄大小，都有发生单侧PA的高风险。
Guidelines by the Endocrine Society Guideline on bypassing adrenal vein sampling (AVS) in patients <35 years old with marked primary aldosteronism (PA) (hypokalemia and elevated plasma aldosterone concentration [PAC]) and a unilateral lesion on computed tomography (CT) are based on limited number of studies. We aimed to determine the accuracy of CT in PA patients according to age. In this retrospective study, we investigated the concordance between CT and AVS in 466 PA patients from two tertiary centers who successfully underwent AVS. CT had an overall accuracy of 64.4% (300/466). In the group with unilateral lesion, patients with hypokalemia had higher concordance than those without hypokalemia (85.0% vs. 43.6%, P<0.001). In the group with marked PA (hypokalemia and PAC >15.9 ng/dL) and unilateral lesion, accuracy of CT was 84.6% (11/13) in patients aged <35 years; 100.0% (20/20), aged 35 to 39 years; 89.4% (59/66), aged 40 to 49 years; and 79.8% (79/99), aged ≥50 years. Cut-off age and PAC for concordance was <50 years and >29.6 ng/dL, respectively. The significant difference in accuracy of CT in 198 patients with marked PA and a unilateral lesion between the <50-year age group and ≥50-year age group (90.9% vs. 79.8%, P=0.044) disappeared in 139 of 198 patients with PAC > 30.0 ng/dL (91.9% vs. 87.7%, P=0.590). Patients with hypokalemia, PAC >30.0 ng/dL, and unilateral lesion were at high risk of unilateral PA regardless of age.