Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Internal Medicine, Houju Memorial Hospital, Nomi, Ishikawa, 923-1226, Japan.
Hypertens Res. 2019 Dec;42(12):1942-1950. doi: 10.1038/s41440-019-0310-y. Epub 2019 Aug 13.
The primary aldosteronism (PA) subtype is usually confirmed by CT and adrenal venous sampling (AVS). However, the subtype diagnosis by AVS is not necessarily consistent with the subtype diagnosis by CT. Patients with PA who show bilateral lesions (normal-appearing adrenals or bilateral adrenal nodules) on CT but unilateral disease on AVS are often found. The aim of this study was to evaluate whether patients with PA subtype discordance between CT and AVS obtain benefits from unilateral adrenalectomy. We retrospectively analyzed 362 consecutive patients with PA who underwent both CT and adrenocorticotropic hormone-unstimulated AVS at Kanazawa University Hospital. Surgical outcomes for unilateral PA were evaluated according to the criteria of the Primary Aldosteronism Surgical Outcome study. In our study, the success rate of AVS in patients with bilateral lesions on CT was 89% (191/214). Furthermore, the discordance rate between CT and AVS in patients with bilateral lesions on CT was 39% (74/191). After surgery, patients with bilateral lesions on CT but unilateral disease on AVS (n = 17) had a lower complete biochemical success rate than those with unilateral lesions on CT and ipsilateral disease on AVS (n = 30) (41% vs. 80%, p = 0.01), but clinical and biochemical benefits (the complete and partial success combined) were not significantly different between them (76% vs. 93% (p = 0.11) and 70% vs. 90% (p = 0.10), respectively). In conclusion, patients with bilateral lesions on CT but unilateral disease on AVS benefited from surgery, and AVS should be performed for patients who pursue surgical management when the CT findings suggest bilateral lesions.
原醛症（PA）亚型通常通过 CT 和肾上腺静脉取样（AVS）来确认。然而，AVS 确定的亚型诊断不一定与 CT 确定的亚型诊断一致。在 CT 上显示双侧病变（外观正常的肾上腺或双侧肾上腺结节）但 AVS 上单侧疾病的 PA 患者经常被发现。本研究旨在评估 CT 和 AVS 结果不一致的 PA 患者是否从单侧肾上腺切除术获益。我们回顾性分析了在金泽大学医院接受 CT 和促肾上腺皮质激素非刺激 AVS 的 362 例连续 PA 患者。根据原发性醛固酮增多症手术结果研究的标准评估单侧 PA 的手术结果。在我们的研究中，CT 显示双侧病变患者 AVS 的成功率为 89%（191/214）。此外，CT 显示双侧病变患者与 AVS 之间的不一致率为 39%（74/191）。手术后，CT 显示双侧病变但 AVS 单侧疾病的患者（n=17）的完全生化缓解率低于 CT 显示单侧病变和 AVS 同侧疾病的患者（n=30）（41%比 80%，p=0.01），但他们的临床和生化获益（完全和部分缓解之和）没有显著差异（76%比 93%（p=0.11）和 70%比 90%（p=0.10））。总之，CT 显示双侧病变但 AVS 单侧疾病的患者从手术中获益，当 CT 结果提示双侧病变时，应进行 AVS 以帮助那些寻求手术治疗的患者。
