Rossitto Giacomo, Miotto Diego, Battistel Michele, Barbiero Giulio, Maiolino Giuseppe, Bisogni Valeria, Sanga Viola, Rossi Gian Paolo
aDepartment of Medicine, DIMED, Clinica dell'Ipertensione Arteriosa, University Hospital bInstitute of Radiology, University of Padua, Padua, Italy.
J Hypertens. 2016 Nov;34(11):2258-65. doi: 10.1097/HJH.0000000000001082.
As metoclopramide stimulates aldosterone secretion, we tested its usefulness in the assessment of lateralization of primary aldosteronism by adrenal vein sampling (AVS).
Prospective within-patient study in consecutive patients undergoing AVS for primary aldosteronism subtyping.
We compared the diagnostic accuracy of baseline and postmetoclopramide lateralization index and relative (to cortisol) aldosterone secretion indices (RASI) for each adrenal gland with aldosterone-producing adenoma (APA) determined by the four corners criteria as the reference diagnosis.
We recruited 93 consecutive patients (mean age: 52 years; women 31%). Metoclopramide increased plasma aldosterone in the inferior vena cava and in both adrenal veins. The postmetoclopramide lateralization index was accurate in identifying APA, but did not increase diagnostic accuracy over baseline lateralization index, because the RASI increased similarly in both sides. Conversely, metoclopramide raised RASI to values more than 0.90 bilaterally in non-APA patients allowing accurate identification of factitious aldosterone suppression. In contrast, RASI was 0.90 or less in 48% contralateral to the tumor in APA patients. Regression analysis showed the APA patients with persistent suppression of RASI contralaterally showed a more florid primary aldosteronism phenotype.
Metoclopramide does not enhance lateralization of aldosterone excess in APA, but consistently increased the value of RASI in non-APA cases, thus unmasking potentially misleading suppression of aldosterone. Postmetoclopramide RASI may therefore allow a more precise diagnosis when AVS can be achieved only unilaterally.
由于甲氧氯普胺可刺激醛固酮分泌，我们测试了其在通过肾上腺静脉采血（AVS）评估原发性醛固酮增多症侧别方面的效用。
对连续接受AVS以进行原发性醛固酮增多症亚型分型的患者进行前瞻性自身对照研究。
我们将基线和甲氧氯普胺后侧别指数以及每个肾上腺的相对（相对于皮质醇）醛固酮分泌指数（RASI）的诊断准确性与以四个象限标准确定的醛固酮瘤（APA）作为参考诊断进行了比较。
我们纳入了93例连续患者（平均年龄：52岁；女性占31%）。甲氧氯普胺使下腔静脉和双侧肾上腺静脉中的血浆醛固酮增加。甲氧氯普胺后侧别指数在识别APA方面是准确的，但与基线侧别指数相比并未提高诊断准确性，因为双侧的RASI增加相似。相反，在非APA患者中，甲氧氯普胺使双侧RASI升高至超过0.90，从而能够准确识别假性醛固酮抑制。相比之下，在APA患者中，肿瘤对侧的RASI在48%的情况下为≤0.90。回归分析显示，对侧RASI持续受抑制的APA患者表现出更明显的原发性醛固酮增多症表型。
甲氧氯普胺不会增强APA中醛固酮过量的侧别，但在非APA病例中持续增加RASI的值，从而揭示潜在的误导性醛固酮抑制。因此，当只能进行单侧AVS时，甲氧氯普胺后RASI可能有助于更精确的诊断。
