Department of Medical Sciences, Division of Internal Medicine and Hypertension Unit, University of Torino, Torino, Italy.
Service of Radiology, University of Torino, Torino, Italy.
Lancet Diabetes Endocrinol. 2015 Apr;3(4):296-303. doi: 10.1016/S2213-8587(14)70069-5. Epub 2014 May 13.
Primary aldosteronism comprises subtypes that need different therapeutic strategies. Adrenal vein sampling is recognised by Endocrine Society guidelines as the only reliable way to correctly diagnose the subtype of primary aldosteronism. Unfortunately, despite being the gold-standard procedure, no standardised procedure exists either in terms of performance or interpretation criteria. In this Personal View, we address several questions that clinicians are presented with when considering adrenal vein sampling. For each of these questions we provide responses based on the available evidence, and opinions based on our experience. In particular, we discuss the most appropriate way to prepare the patient, whether adrenal vein sampling can be avoided for some subgroups of patients, the use of ACTH (1-24) during the procedure, the most appropriate criteria for interpretation of adrenal vein cannulation and lateralisation, the use of contralateral suppression, and strategies to improve success rates of adrenal vein sampling in centres with little experience.
原醛症包括需要不同治疗策略的亚型。内分泌学会指南将肾上腺静脉取样确认为正确诊断原醛症亚型的唯一可靠方法。不幸的是，尽管它是金标准程序，但在操作或解释标准方面都没有标准程序。在这篇个人观点中，我们讨论了临床医生在考虑肾上腺静脉取样时遇到的几个问题。对于这些问题中的每一个，我们都根据现有证据提供了答复，并根据我们的经验提供了意见。特别是，我们讨论了最适合准备患者的方法，对于某些亚组患者是否可以避免肾上腺静脉取样，在手术过程中使用 ACTH（1-24），解释肾上腺静脉插管和侧化的最合适标准，使用对侧抑制，以及在经验较少的中心提高肾上腺静脉取样成功率的策略。
