Tanemoto Masayuki, Suzuki Takehiro, Abe Michiaki, Abe Takaaki, Ito Sadayoshi
Division of Nephrology, Hypertension & Endocrinology, Department of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan.
Eur J Endocrinol. 2009 Mar;160(3):459-63. doi: 10.1530/EJE-08-0840. Epub 2008 Dec 2.
Differentiating unilateral form from bilateral is a critical diagnostic step in primary aldosteronism (PA), for which adrenal vein sampling (AVS) is accepted to be the most reliable. However, variance of corticotropin could affect the diagnosis in AVS.
We conducted simultaneous bilateral AVS on ten biochemically diagnosed PA cases, and used the aldosterone-to-cortisol ratio (A/C) of the samples for the diagnosis. The diagnosis by AVS after a low-dose (0.1 microg) ACTH stimulation, which can provoke maximum-physiologic corticotropic response, was compared with those before the stimulation and after the standard-dose (250 microg) ACTH stimulation.
In half of the cases, the low-dose pre-stimulation affected the diagnosis. In four out of ten cases, the side-to-side ratios of A/C were changed in the basal/low-dose/standard-dose AVS as 6.62/2.46/0.63, 2.13/0.41/0.14, 1.88/2.38/2.40, and 1.96/2.27/1.90 respectively. In three out of ten cases, the adrenal vein to the matching inferior vena cava ratio of A/C was also changed across 1, the cut-off to indicate suppression of aldosterone secretion. Additionally, the confirmation of successful sampling was difficult in five out of ten and two out of ten cases of the basal and low-dose AVS respectively, whereas it was easy in all the cases of the standard-dose AVS.
The diagnosis in the basal AVS could be affected by the physiologic fluctuation of ACTH at relatively high prevalence. The basal AVS would be unreliable to differentiate two forms of PA.
区分原发性醛固酮增多症（PA）的单侧与双侧形式是关键的诊断步骤，肾上腺静脉采血（AVS）被认为是最可靠的方法。然而，促肾上腺皮质激素的变化可能会影响AVS的诊断。
我们对10例经生化诊断的PA患者进行了同步双侧AVS，并使用样本的醛固酮与皮质醇比值（A/C）进行诊断。将低剂量（0.1微克）促肾上腺皮质激素释放激素（ACTH）刺激后（可引发最大生理促肾上腺皮质激素反应）的AVS诊断结果与刺激前及标准剂量（250微克）ACTH刺激后的诊断结果进行比较。
半数病例中，低剂量刺激前影响诊断。10例中有4例，基础/低剂量/标准剂量AVS中A/C的左右比值分别为6.62/2.46/0.63、2.13/0.41/0.14、1.88/2.38/2.40和1.96/2.27/1.90。10例中有3例，肾上腺静脉与匹配的下腔静脉的A/C比值在1（表明醛固酮分泌受抑制的临界值）上下也发生了变化。此外，基础AVS和低剂量AVS分别有10例中的5例和10例中的2例难以确认采样成功，而标准剂量AVS的所有病例都很容易确认。
基础AVS的诊断可能受ACTH生理波动影响，发生率相对较高。基础AVS在区分两种PA形式时不可靠。
