Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, UK.
Hormones (Athens). 2012 Apr-Jun;11(2):151-9. doi: 10.14310/horm.2002.1342.
Adrenal vein sampling (AVS) is recommended in all patients with hyperaldosteronism to whom surgery would be offered if the results indicated unilateral hypersecretion.
To assess the performance of AVS against radiological findings and to evaluate the Endocrine Society's Practice Guidelines for diagnostic cut-offs.
Retrospective study of 41 patients with hyperaldosteronism who underwent both AVS and computed tomography (CT) imaging.
CT and AVS results were concordant in 73.7%. Unilateral lesions on CT had a greater positive predictive value (85%) than non-unilateral lesions (50%). In patients with subsequently confirmed adrenal adenomas, a lateralisation ratio >2 when comparing cortisol-corrected aldosterone ratios from the affected versus unaffected side was 100% sensitive. Patients who were managed surgically experienced significant reductions in blood pressure and medication burden and 46% were cured.
AVS is important in establishing unilateral or bilateral adrenal secretion of aldosterone in patients with primary hyperaldosteronism. However, it may not be essential for the work-up in patients below the age of 40, in whom adrenal incidentalomas adrenal incidentalomas are known to be rarer, and a unilateral lesion on CT therefore has a greater positive predictive value.
对于所有拟行手术治疗的原发性醛固酮增多症患者，均建议进行肾上腺静脉取样（AVS），以明确单侧醛固酮分泌过多。
评估 AVS 对影像学检查结果的诊断效能，并评价美国临床内分泌医师协会（Endocrine Society）的诊断切点临床实践指南。
回顾性分析了 41 例接受 AVS 和计算机断层扫描（CT）检查的原发性醛固酮增多症患者。
CT 和 AVS 结果一致的比例为 73.7%。单侧病变的 CT 检查阳性预测值（85%）高于非单侧病变（50%）。在随后经手术证实为肾上腺腺瘤的患者中，当比较受影响和未受影响侧校正皮质醇后的醛固酮比值时，侧化比值>2 的患者敏感性为 100%。接受手术治疗的患者血压和药物负担显著降低，46%的患者被治愈。
在原发性醛固酮增多症患者中，AVS 对于确定单侧或双侧肾上腺醛固酮分泌具有重要意义。然而，对于年龄<40 岁的患者，AVS 可能并非必需，因为已知该年龄段的肾上腺意外瘤较少，因此 CT 上的单侧病变具有更高的阳性预测值。
