Faculty of Arts and Science, Queen's University, Kingston ON, Canada.
Clin Biochem. 2013 Oct;46(15):1399-404. doi: 10.1016/j.clinbiochem.2013.04.004. Epub 2013 Apr 16.
Adrenal vein sampling (AVS) is the gold standard for localization of aldosterone producing adenoma. The anatomy of the right adrenal vein makes this procedure technically demanding and it may yield no clinical information if the adrenal veins are not adequately cannulated. Having frequently observed the technical failure of AVS, we undertook a review of 220 procedures in British Columbia, Canada.
Subjects were retrospectively identified through the laboratory information system. The following were collected: demographics, screening aldosterone concentration and renin activity/mass, results of dynamic function tests, AVS aldosterone and cortisol results. Standard calculations were performed on AVS data and site-specific success rates were compared. The effect of adrenocorticotropin hormone (ACTH) stimulation on the selectivity index (SI) and lateralization index (LI) were explored.
The overall technical success-rate of AVS procedures was only 44% in procedures where no ACTH-stimulation was used (n=200) but this rose significantly (p<0.01) to 82% for those employing ACTH (n=139). ACTH-stimulation significantly increased the median SI (left: 5.8 vs 36.7, p<0.01; right: 7.0 vs 51.2, p<0.01), and salvaged 36 procedures from yielding no information, 21 of which demonstrated lateralization of aldosterone production. In 64 cases showing lateralization both pre and post-stimulation, ACTH significantly decreased the median LI from 5.4 to 2.2, p<0.01, creating substantial risk for spurious loss of lateralization.
The technical success of AVS is lower than reported elsewhere. Provided that effects on the LI are considered, the use of ACTH-stimulation during AVS assists in the identification of unilateral forms of PA.
肾上腺静脉采样（AVS）是定位醛固酮产生腺瘤的金标准。由于右肾上腺静脉的解剖结构，该操作具有较高的技术要求，如果肾上腺静脉未充分插管，可能无法提供临床信息。我们在频繁观察到 AVS 技术失败后，对加拿大不列颠哥伦比亚省的 220 例手术进行了回顾性研究。
通过实验室信息系统回顾性确定研究对象。收集的内容包括：人口统计学资料、筛查醛固酮浓度和肾素活性/质量、动态功能试验结果、AVS 醛固酮和皮质醇结果。对 AVS 数据进行标准计算，并比较了特定部位的成功率。还探讨了促肾上腺皮质激素（ACTH）刺激对选择性指数（SI）和侧化指数（LI）的影响。
在未使用 ACTH 刺激的 200 例 AVS 手术中，该手术的整体技术成功率仅为 44%（n=200），但在使用 ACTH 的 139 例手术中，成功率显著提高（p<0.01）。ACTH 刺激显著增加了 SI 的中位数（左侧：5.8 比 36.7，p<0.01；右侧：7.0 比 51.2，p<0.01），并使 36 例无信息的手术获得了结果，其中 21 例显示了醛固酮产生的侧化。在 64 例术前和术后均显示侧化的病例中，ACTH 使 LI 的中位数从 5.4 显著降低至 2.2（p<0.01），这极大地增加了侧化假性丢失的风险。
AVS 的技术成功率低于其他地方的报道。如果考虑到对 LI 的影响，在 AVS 期间使用 ACTH 刺激有助于识别单侧形式的 PA。
