Patel Shilpan M, Lingam Ravi K, Beaconsfield Tina I, Tran Tan L, Brown Beata
Department of Radiology, Central Middlesex and Northwick Park Hospitals, North West London Hospitals Trust, Watford Rd, Harrow HA1 3UJ, England.
Radiographics. 2007 Jul-Aug;27(4):1145-57. doi: 10.1148/rg.274065150.
The diagnosis of primary aldosteronism, the most common form of secondary hypertension, is based on clinical and biochemical features. Although radiology plays no role in the initial diagnosis, it has an important role in differentiating between the two main causes of primary aldosteronism: aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). This distinction is important because APAs are generally managed surgically and BAH medically. Adrenal venous sampling is considered the standard of reference for determining the cause of primary aldosteronism but is technically demanding, operator dependent, costly, and time consuming, with a low but significant complication rate. Other imaging modalities, including computed tomography, magnetic resonance imaging, and adrenal scintigraphy, have also been used to determine the cause of primary aldosteronism. Cross-sectional imaging has traditionally focused on establishing the diagnosis of an APA, with that of BAH being one of exclusion. A high specificity for detecting an APA is desirable, since it will avert unnecessary surgery in patients with BAH. However, an overreliance on cross-sectional imaging can lead to the incorrect treatment of affected patients, mainly due to the wide variation in the reported diagnostic performance of these modalities. A combination of modalities is usually required to confidently determine the cause of primary aldosteronism. The quest for optimal radiologic management of primary aldosteronism continues just over a half century since this disease entity was first described.
原发性醛固酮增多症是继发性高血压最常见的形式，其诊断基于临床和生化特征。虽然放射学在初始诊断中不起作用，但它在区分原发性醛固酮增多症的两个主要病因方面具有重要作用：醛固酮瘤（APA）和双侧肾上腺增生（BAH）。这种区分很重要，因为APA通常通过手术治疗，而BAH则采用药物治疗。肾上腺静脉采血被认为是确定原发性醛固酮增多症病因的参考标准，但技术要求高、依赖操作人员、成本高且耗时，并发症发生率虽低但有统计学意义。其他成像方式，包括计算机断层扫描、磁共振成像和肾上腺闪烁显像，也已用于确定原发性醛固酮增多症的病因。传统上，横断面成像主要侧重于确立APA的诊断，而BAH的诊断则是排除性诊断。检测APA需要高特异性，因为这将避免对BAH患者进行不必要的手术。然而，过度依赖横断面成像可能导致对受影响患者的治疗错误，主要是由于这些成像方式所报告的诊断性能差异很大。通常需要结合多种成像方式才能可靠地确定原发性醛固酮增多症的病因。自首次描述这种疾病实体以来，半个多世纪过去了，对原发性醛固酮增多症进行最佳放射学管理的探索仍在继续。
