Ladurner Roland, Sommerey Sandra, Buechner Stefan, Dietz Anna, Degenhart Christoph, Hallfeldt Klaus, Gallwas Julia
Chirurgische Klinik II, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
Medizinische Klinik IV, Campus Innenstadt, Ludwig-Maximilians Universität München, Munich, Germany.
Eur J Clin Invest. 2017 May;47(5):372-377. doi: 10.1111/eci.12746. Epub 2017 Apr 7.
The correct differentiation between unilateral and bilateral adrenal involvement in patients with primary aldosteronism (PA) is of utmost importance to justify surgical treatment. The aim of this study was to determine the accuracy of adrenal imaging compared to adrenal venous sampling (AVS), histopathology and postoperative outcome.
The data of all patients with unequivocal AVS who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism between May 2004 and April 2015 were entered in this retrospective study. We compared computed tomography (CT) and magnetic resonance imaging (MRI) results with corresponding AVS data, histopathology findings and postoperative outcome.
A total of 175 patients underwent unilateral laparoscopic adrenalectomy for primary aldosteronism. AVS was successful in 152 patients and postoperative outcome available in 148 patients. Despite unilateral disease according to AVS results, bilateral normal glands were seen in 15 MRI (17·2%) and 7 CT scans (8·5%), respectively. Unilateral enlargement of the nonhypersecreting adrenal gland was found in three MRI (3·5%) and 10 CT scans (12·2%) of patients who showed aldosterone hypersecretion deriving from the contralateral gland. Fifteen MRI (17·2%) and 18 CT scans (22·0%) revealed bilateral adrenal pathology despite unilateral aldosterone hypersecretion.
The accuracy of CT and magnetic resonance imaging in predicting unilateral disease is poor. AVS appears to be an essential diagnostic step to identify those patients who may benefit from unilateral adrenalectomy.
对于原发性醛固酮增多症（PA）患者，准确区分单侧和双侧肾上腺受累对于证明手术治疗的合理性至关重要。本研究的目的是确定肾上腺成像与肾上腺静脉采样（AVS）、组织病理学及术后结果相比的准确性。
本回顾性研究纳入了2004年5月至2015年4月间因原发性醛固酮增多症接受单侧腹腔镜肾上腺切除术且AVS明确的所有患者的数据。我们将计算机断层扫描（CT）和磁共振成像（MRI）结果与相应的AVS数据、组织病理学发现及术后结果进行了比较。
共有175例患者因原发性醛固酮增多症接受了单侧腹腔镜肾上腺切除术。152例患者AVS成功，148例患者有术后结果。尽管根据AVS结果为单侧疾病，但分别在15例MRI（17.2%）和7例CT扫描（8.5%）中发现双侧肾上腺正常。在显示对侧腺体醛固酮分泌过多的患者中，3例MRI（3.5%）和10例CT扫描（12.2%）发现非分泌亢进侧肾上腺单侧增大。15例MRI（17.2%）和18例CT扫描（22.0%）显示尽管醛固酮分泌为单侧亢进，但存在双侧肾上腺病变。
CT和磁共振成像在预测单侧疾病方面准确性较差。AVS似乎是识别那些可能从单侧肾上腺切除术中获益的患者的关键诊断步骤。
