Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?
Should Adrenal Venous Sampling Be Performed in PA Patients Without Apparent Adrenal Tumors?
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DOI：
10.3389/fendo.2021.645395
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发表时间：
2021
影响因子：
5.2
通讯作者：
Naruse M
中科院分区：
文献类型：
--
作者：
Okamoto K;Ohno Y;Sone M;Inagaki N;Ichijo T;Yoneda T;Tsuiki M;Wada N;Oki K;Tamura K;Kobayashi H;Izawa S;Tanabe A;Naruse M
有些产生醛固酮的微腺瘤不能通过图像检查发现。因此，肾上腺静脉取样（AVS）经常进行，即使在原发性醛固酮增多症（PA）患者没有明显的肾上腺肿瘤（AT）的成像。然而，在大多数情况下，巴勒斯坦权力机构是双边的。考虑肾上腺切除术的发生率，阐明无明显房性心动过速的PA患者对AVS的临床需求。这是一项回顾性横断面研究，评估了多中心日本PA研究（JPAS）中1586例无明显AT的PA患者。我们分析了哪些参数可以用来区分单侧PA患者没有明显的AT从双侧患者。我们还分析了单侧PA患者肾上腺切除术的患病率。在1586例PA患者中，200例（12.6%）诊断为单侧亚型，无明显AT。年轻女性、高血压病程短、血钾正常、低肌酐水平、低血浆醛固酮浓度和低醛固酮-肾素比值（ARR）在双侧PA患者中明显多于单侧PA患者。如果无明显房性心动过速的PA患者为女性，血钾正常，ARR低（<560 pg/ml/ng/ml/h），则单侧PA的发生率仅为5/444（1.1%）。此外，200例患者中有77例（38.5%）未接受肾上腺切除术，尽管根据AVS诊断为单侧亚型。无明显房性心动过速的PA患者中单侧亚型的低患病率表明，AVS不适用于所有这些患者。在无明显房性心动过速的正常血钾PA女性患者中，如果ARR不高，则可跳过AVS。然而，对于ARR高的男性低钾血症PA患者应考虑AVS，因为这些患者中单侧亚型的发生率较高。
Some aldosterone-producing micro-adenomas cannot be detected through image inspection. Therefore, adrenal venous sampling (AVS) is often performed, even in primary aldosteronism (PA) patients who have no apparent adrenal tumors (ATs) on imaging. In most of these cases, however, the PA is bilateral. To clarify the clinical need for AVS in PA patients without apparent ATs, taking into consideration the rates of adrenalectomy. This is a retrospective cross-sectional study assessing 1586 PA patients without apparent ATs in the multicenter Japan PA study (JPAS). We analyzed which parameters could be used to distinguish unilateral PA patients without apparent ATs from bilateral patients. We also analyzed the prevalences of adrenalectomy in unilateral PA patients. The unilateral subtype without an apparent AT was diagnosed in 200 (12.6%) of 1586 PA patients. Being young and female with a short hypertension duration, normokalemia, low creatinine level, low plasma aldosterone concentration, and low aldosterone-to-renin ratio (ARR) was significantly more common in bilateral than unilateral PA patients. If PA patients without apparent ATs were female and normokalemic with a low ARR (<560 pg/ml per ng/ml/h), the rate of unilateral PA was only 5 (1.1%) out of 444. Moreover, 77 (38.5%) of the 200 did not receive adrenalectomy, despite being diagnosed with the unilateral subtype based on AVS. The low prevalence of the unilateral subtype in PA patients without apparent ATs suggests AVS is not indicated for all of these patients. AVS could be skipped in female normokalemic PA patients without apparent ATs if their ARRs are not high. However, AVS should be considered for male hypokalemic PA patients with high ARRs because the rates of the unilateral subtype are high in these patients.
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影响因子：
2.7
作者：
Nanba, K.;Tsuiki, M.;Naruse, M.
通讯作者：
Naruse, M.
影响因子：
8.3
作者：
Monticone, Silvia;Satoh, Fumitoshi;Mulatero, Paolo
通讯作者：
Mulatero, Paolo
DOI：
10.1161/circoutcomes.115.002002
发表时间：
2015-11
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Lubitz CC;Economopoulos KP;Sy S;Johanson C;Kunzel HE;Reincke M;Gazelle GS;Weinstein MC;Gaziano TA
通讯作者：
Gaziano TA
影响因子：
41.5
作者：
Brown, Nancy J.
通讯作者：
Brown, Nancy J.
影响因子：
13.2
作者：
Matsuo, Seiichi;Imai, Enyu;Hishida, Akira
通讯作者：
Hishida, Akira