Assistance Publique-Hôpitaux de Paris, Hypertension Unit, and Université Paris-Descartes, Faculty of Medicine, 4 rue de la Chine, F-75020 Paris, France.
J Clin Endocrinol Metab. 2012 Oct;97(10):3530-7. doi: 10.1210/jc.2012-1917. Epub 2012 Aug 23.
Adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is lateralized in patients with primary aldosteronism. However, this procedure is invasive, poorly standardized, and not widely available.
Our goal was to identify patients' characteristics that can predict unilateral aldosterone hypersecretion in some patients who could hence bypass adrenal venous sampling before surgery.
A cross-sectional diagnostic study was performed from February 2009 to July 2010 at a single center specialized in hypertension care.
A total of 101 consecutive patients with primary aldosteronism who underwent adrenal venous sampling participated in the study. The autonomy of aldosterone hypersecretion was assessed with the saline infusion test.
Adrenal venous sampling was performed without ACTH infusion but with simultaneous bilateral sampling.
Variables independently associated with a lateralized adrenal venous sampling in multivariate logistic regression were used to derive a clinical prediction rule.
Adrenal venous sampling was successful in 87 patients and lateralized in 49. All 26 patients with a typical Conn's adenoma plus serum potassium of less than 3.5 mmol/liter or estimated glomerular filtration rate of at least 100 ml/min/1.73 m2 (or both) had unilateral primary aldosteronism; this rule had 100% specificity (95% confidence interval, 91-100) and 53% sensitivity (95% confidence interval, 38-68).
If our results are validated on an independent sample, adrenal venous sampling could be omitted before surgery in patients with a typical Conn's adenoma if they meet at least one of two supplementary biochemical characteristics (serum potassium<3.5 mmol/liter or estimated glomerular filtration rate ≥100 ml/min/1.73 m2).
在原发性醛固酮增多症患者中，推荐采用肾上腺静脉取样来评估醛固酮分泌是否侧化。然而，该操作具有侵袭性、标准化程度低，并且无法广泛应用。
我们的目标是确定一些患者的特征，这些特征可以预测某些患者的单侧醛固酮分泌过多，这些患者在手术前可以绕过肾上腺静脉取样。
这是一项 2009 年 2 月至 2010 年 7 月在一家专门治疗高血压的中心进行的单中心、横断面诊断研究。
共有 101 例连续的原发性醛固酮增多症患者接受了肾上腺静脉取样，所有患者均进行了盐水输注试验以评估醛固酮分泌自主性。
肾上腺静脉取样在无 ACTH 输注但双侧同步取样的情况下进行。
在多变量逻辑回归中，与侧化的肾上腺静脉取样独立相关的变量被用于推导临床预测规则。
87 例患者的肾上腺静脉取样成功，其中 49 例为侧化。所有 26 例具有典型 Conn 腺瘤且血清钾<3.5mmol/L 或估计肾小球滤过率≥100ml/min/1.73m2（或两者兼有）的患者均存在单侧原发性醛固酮增多症；该规则的特异性为 100%（95%置信区间，91-100），敏感性为 53%（95%置信区间，38-68）。
如果我们的结果在独立样本中得到验证，那么如果具有典型 Conn 腺瘤的患者至少符合两种补充生化特征中的一种（血清钾<3.5mmol/L 或估计肾小球滤过率≥100ml/min/1.73m2），则在手术前可以省略肾上腺静脉取样。
