Image-Derived Enzymatic Adrenal Lateralisation of Primary Hyperaldosteronism (IDEAL)

高血压是一种严重的医疗状况，随着时间的推移，会对心脏和血管造成损害。如果不及时治疗，高血压往往会导致危及生命的疾病，如心脏病发作，中风（脑出血），肾脏疾病和痴呆症（记忆问题）。对于大多数人来说，生活方式的改变和降压药物的治疗可以使血压恢复到健康水平。然而，有时高血压并不容易控制。尤其是当有其他潜在的条件，提高血压。在大约十分之一的高血压患者中（英国有超过50万人），这种情况是由体内一种称为醛固酮的化学物质过多引起的。这种情况（醛固酮增多症）很难治疗，受影响的人有特别高的风险损害心脏，肾脏和患有痴呆症。患有醛固酮增多症的患者通常需要在余生中服用多种药物（3-5种药物），并且可能会降低生活质量。然而，对于其中一些患者（约四分之一），去除产生过多醛固酮的腺体（肾上腺）可以治愈高血压，或者至少有助于减少对降压药物的需求。不幸的是，很少有醛固酮增多症患者（英国每年约300例）有机会接受手术治疗，因为没有实用的方法来确定那些可能受益的人。为了手术成功，最重要的是要知道切除哪一个腺体-身体左侧或右侧的腺体。这只能通过从左右肾上腺内的微小血管中采集血液样本来确定，这一过程非常困难，只有少数人可以在英国进行。我们研究的目标是更容易识别那些可能从手术中受益的醛固酮增多症患者，并确定切除哪个腺体（左或右），以便更多的人可以接受手术治疗。我们开发了一种“化学染料”，用于先进的医学成像，称为正电子发射断层扫描（PET）。如果“染料”如我们所希望的那样起作用，PET扫描将使我们能够看到两个肾上腺（左和右）中的每一个产生多少醛固酮。这将有助于确定哪些患者最有可能从手术中受益，并确定切除哪个肾上腺。在这项研究中，我们将调查是否PET扫描与“染料”可以用来衡量醛固酮增多症患者的肾上腺醛固酮的生产。

High blood pressure is a serious medical condition that, over time, causes damage to the heart and blood vessels. If left untreated, high blood pressure often leads to life threatening conditions, such as heart attack, stroke (bleeding in the brain), kidney disease and dementia (memory problems). For most people, lifestyle changes, and treatment with blood pressure lowering medication, return the blood pressure to healthy levels. However, sometimes high blood pressure cannot easily be controlled. This is particularly the case when there are other underlying conditions that raise the blood pressure. In about 1 out of 10 patients with high blood pressure (over half a million people in the UK), the condition is caused by too high production of a chemical, known as aldosterone, in the body. This condition (hyperaldosteronism) is very difficult to treat, and those affected have a particularly high risk of damaging the heart, kidneys and suffering from dementia. Patients with hyperaldosteronism will often need to take a number of medications (3-5 drugs) for the rest of their life, and are likely to have reduced life quality. However, for some of these patients (about one in four), removal of the gland (adrenal) that produces too much aldosterone can cure the high blood pressure, or at the very least, help reduce the need for blood pressure reducing medication. Unfortunately, very few patients with hyperaldosteronism (about 300 per year in the UK) are offered the chance to be treated with surgery as there are no practical methods to identify those who are likely to benefit. For surgery to be successful, it is of outmost importance to know which gland to remove - the one on the left or right side of the body. This can only be determined by taking blood samples from tiny blood vessels within the left and right adrenal glands, a procedure so difficult that it can only be performed by a handful of people in the UK. The goal of our research is to make it much easier to identify those patients with hyperaldosteronism who are likely to benefit from surgery, and to determine which gland (left or right) to remove, so that more people can be offered surgical treatment. We have developed a kind of 'chemical dye' for use with an advanced type of medical imaging, known as positron emission tomography (PET). If the 'dye' works as we hope, the PET scan will allow us to see how much aldosterone that each of the two adrenal glands (left and right) produce. This will make it possible to identify the patients who are most likely to benefit from surgery, and to determine which adrenal gland to remove. For this study, we will investigate if PET scanning with the 'dye' can be used to measure aldosterone production in adrenal glands in patients with hyperaldosteronism.