Significance of aldosterone gradient within left adrenal vein in diagnosing unilateral subtype of primary aldosteronism
Significance of aldosterone gradient within left adrenal vein in diagnosing unilateral subtype of primary aldosteronism
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DOI：
10.1111/cen.14320
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发表时间：
2020-09-19
影响因子：
3.2
通讯作者：
Ogawa, Yoshihiro
中科院分区：
文献类型：
--
作者：
Ogata, Masatoshi;Umakoshi, Hironobu;Ogawa, Yoshihiro
背景：右肾上腺静脉插管成功率有限。同一肾上腺静脉分支内的醛固酮梯度对醛固酮产生腺瘤具有特异性。目的探讨左肾上腺静脉内醛固酮绝对梯度（左室醛固酮绝对梯度）是否提示单侧醛固酮过量。设计与设置在单一转诊中心进行回顾性横断面研究。患者和方法共123例原发性醛固酮增多症患者，均有成功的肾上腺静脉采样（AVS）数据。当主干静脉与中央静脉间醛固酮-皮质醇比值为>4:1时，左室醛固酮绝对梯度被认为是显著的。主要观察指标：单侧亚型在左室醛固酮绝对梯度显著的患者中的患病率。结果左室醛固酮绝对梯度明显高于无左室醛固酮绝对梯度的患者（88.2% [15/17]vs 21.7% [23/106],P < 0.001）。在60例自发性低钾血症、计算机断层扫描显示的左单侧疾病或两者兼有的患者中，只有AVS单侧亚型患者（42.9%[15/35]）存在显著的左室醛固酮绝对梯度，而双侧亚型患者（0.0%[0/25]）没有。这些数据在外部队列中得到了验证。结论自发性低钾血症、ct显示的左单侧病变或同时伴有左单侧病变的AVS患者，其左室醛固酮绝对梯度明显可用于诊断原发性醛固酮增多症的左单侧亚型。
Context The success rate of cannulation of the right adrenal vein is limited. The aldosterone gradient within the same adrenal vein branch is specific for aldosterone-producing adenoma. Objective This study was performed to investigate whether the absolute aldosterone gradient within the left adrenal vein (left-AV absolute aldosterone gradient) indicates unilateral excess aldosterone. Design and setting A retrospective cross-sectional study in a single referral centre. Patients and methods In total, 123 consecutive patients with primary aldosteronism who had successful adrenal vein sampling (AVS) data were examined. The left-AV absolute aldosterone gradient was considered significant when a gradient of >4:1 in the aldosterone-to-cortisol ratio between the common trunk vein and central vein was found. Main outcome measure The prevalence of the unilateral subtype in patients with a significant left-AV absolute aldosterone gradient. Results The prevalence of the unilateral subtype was higher in patients with than without a significant left-AV absolute aldosterone gradient (88.2% [15/17] vs 21.7% [23/106],P < .001). Of 60 patients with spontaneous hypokalemia, left unilateral disease on computed tomography, or both, a significant left-AV absolute aldosterone gradient was present only in patients with the unilateral subtype on AVS (42.9% [15/35]), but not in those with the bilateral subtype (0.0% [0/25]). These data were validated in an external cohort. Conclusion The presence of a significant left-AV absolute aldosterone gradient can be used to diagnose the left unilateral subtype of primary aldosteronism on AVS in patients with spontaneous hypokalemia, left unilateral disease on computed tomography or both.