Department of Endocrinology.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.
J Hypertens. 2021 Feb 1;39(2):310-317. doi: 10.1097/HJH.0000000000002634.
The role of adrenal venous sampling (AVS) has been challenged by some recent evidence. This study aimed to compare the role of AVS and computed tomography (CT) in the management of primary aldosteronism.
Patients who underwent unilateral adrenalectomy for primary aldosteronism at a single center between January 2015 and December 2018 were included, and postoperative outcomes of the patients who underwent surgery based on CT (n = 195) or AVS (n = 40) were compared. The data of all the patients who underwent AVS successfully (n = 75) during this period were also collected and analyzed.
There were no significant differences between the CT-guided and AVS-guided adrenalectomies in most of the postoperative outcomes, and the proportion of patients achieving cure of hypokalemia (CT vs. AVS, 98.3 vs. 96.4%) and alleviation of hypertension (89.2 vs. 92.9%) were similar between the two groups. However, since the baseline characteristics of the two groups were not identical, the AVS-guided group showed greater improvement in postoperative hypokalemia and greater reduction in the number of antihypertensive medications than the CT-guided group. In addition, for the 75 patients who underwent AVS successfully, the concordance rate between CT abnormalities and AVS lateralization was 60.0% in total, and 22.7% patients changed treatment plans according to the AVS results.
Although the clinical outcomes were not significantly different between the CT-guided and AVS-guided group, the AVS-guided group seemed to benefit more from the surgery, and a considerable number of patients with primary aldosteronism would have received inappropriate treatment if they did not undergo AVS.
一些最新的证据对肾上腺静脉采样（AVS）的作用提出了质疑。本研究旨在比较 AVS 和计算机断层扫描（CT）在原发性醛固酮增多症治疗中的作用。
纳入 2015 年 1 月至 2018 年 12 月期间在一家中心接受单侧肾上腺切除术治疗原发性醛固酮增多症的患者，并比较基于 CT（n=195）或 AVS（n=40）进行手术的患者的术后结果。还收集并分析了在此期间成功进行 AVS 的所有患者（n=75）的数据。
在大多数术后结果中，CT 引导与 AVS 引导的肾上腺切除术之间没有显著差异，两组患者低钾血症治愈率（CT 与 AVS，98.3%比 96.4%）和高血压缓解率（89.2%比 92.9%）相似。然而，由于两组患者的基线特征不一致，AVS 引导组的术后低钾血症改善程度更大，降压药物数量减少更多。此外，对于成功进行 AVS 的 75 名患者，CT 异常与 AVS 侧化之间的一致性总为 60.0%，根据 AVS 结果改变治疗计划的患者为 22.7%。
尽管 CT 引导与 AVS 引导组的临床结果无显著差异，但 AVS 引导组似乎从手术中获益更多，如果不进行 AVS，相当数量的原发性醛固酮增多症患者将接受不适当的治疗。
