Magill S B, Raff H, Shaker J L, Brickner R C, Knechtges T E, Kehoe M E, Findling J W
Endocrine-Diabetes Center, Department of Medicine, St. Luke's Medical Center, Milwaukee, Wisconsin 53215, USA.
J Clin Endocrinol Metab. 2001 Mar;86(3):1066-71. doi: 10.1210/jcem.86.3.7282.
Determination of the etiology of primary aldosteronism remains a diagnostic challenge. The most common types of primary aldosteronism are bilateral adrenal hyperplasia (BAH), aldosterone-producing adenomas (APA), and primary adrenal hyperplasia. Computed tomography (CT) and adrenal vein sampling (AVS) are the primary modalities used to differentiate these subtypes. The purpose of this study was to compare AVS and CT imaging of the adrenal glands in patients with hyperaldosteronism in whom CT imaging was normal or in whom focal unilateral or bilateral adrenal abnormalities were detected. The diagnosis of primary aldosteronism was made in 62 patients based on an elevated plasma aldosterone to PRA ratio and an elevated urinary aldosterone excretion rate. Thirty-eight patients had CT imaging and successful bilateral adrenal vein sampling and were included in the final analysis. AVS was considered the gold standard in determining the specific subtype of primary aldosteronism. There were 15 patients with APA, 21 patients with BAH, and 2 patients with primary adrenal hyperplasia. Plasma aldosterone was significantly higher in patients with APA (46.3 +/- 8.5 ng/dL; 1284 +/- 235 pmol/L) than in those with BAH (29.3 +/- 2.4 ng/dL; 813 +/- 11 pmol/L; P < 0.05). Plasma potassium was significantly lower in patients with APA (3.1 +/- 0.1 mmol/L) than in patients with BAH (3.5 +/- 0.1 mmol/L; P < 0.02). There was considerable overlap in the other biochemical indices (e.g. PRA and urinary aldosterone) in patients with the different subtypes. In patients with APA proven by AVS, eight had concordant findings with CT imaging, four had discordant findings, and three had normal CT imaging. In patients with BAH proven by AVS, four had concordant findings with CT imaging, eight had discordant findings, and nine had normal CT imaging. Compared with AVS, CT imaging was either inaccurate or provided no additional information in 68% of the patients with primary aldosteronism. We conclude that adrenal CT imaging is not a reliable method to differentiate primary aldosteronism. Adrenal vein sampling is essential to establish the correct diagnosis of primary aldosteronism.
原发性醛固酮增多症病因的确定仍然是一项诊断挑战。原发性醛固酮增多症最常见的类型是双侧肾上腺增生（BAH）、醛固酮分泌腺瘤（APA）和原发性肾上腺增生。计算机断层扫描（CT）和肾上腺静脉采血（AVS）是用于区分这些亚型的主要方法。本研究的目的是比较CT成像正常或检测到局灶性单侧或双侧肾上腺异常的醛固酮增多症患者的肾上腺AVS和CT成像。基于血浆醛固酮与肾素活性（PRA）比值升高和尿醛固酮排泄率升高，62例患者被诊断为原发性醛固酮增多症。38例患者进行了CT成像和成功的双侧肾上腺静脉采血，并纳入最终分析。AVS被认为是确定原发性醛固酮增多症具体亚型的金标准。有15例APA患者、21例BAH患者和2例原发性肾上腺增生患者。APA患者的血浆醛固酮（46.3±8.5 ng/dL；1284±235 pmol/L）显著高于BAH患者（29.3±2.4 ng/dL；813±11 pmol/L；P<0.05）。APA患者的血浆钾（3.1±0.1 mmol/L）显著低于BAH患者（3.5±0.1 mmol/L；P<0.02）。不同亚型患者的其他生化指标（如PRA和尿醛固酮）有相当大的重叠。在经AVS证实的APA患者中，8例CT成像结果一致，4例结果不一致。
