Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Division of Nephrology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Am J Hypertens. 2021 Feb 18;34(1):34-45. doi: 10.1093/ajh/hpaa151.
Variability of aldosterone concentrations has been described in patients with primary aldosteronism.
We performed a retrospective cohort study of 340 patients with primary aldosteronism who underwent adrenal venous sampling (AVS) at a tertiary referral center, 116 of whom also had a peripheral venous aldosterone measured hours before the procedure. AVS was performed by the same interventional radiologist using bilateral, simultaneous sampling, under unstimulated and then stimulated conditions, and each sample was obtained in triplicate. Main outcome measures were: (i) change in day of AVS venous aldosterone from pre-AVS to intra-AVS and (ii) variability of triplicate adrenal venous aldosterone concentrations during AVS.
Within an average duration of 131 minutes, 81% of patients had a decline in circulating aldosterone concentrations (relative decrease of 51% and median decrease of 7.0 ng/dl). More than a quarter (26%) of all patients had an inferior vena cava aldosterone of ≤5 ng/dl at AVS initiation. The mean coefficient of variation of triplicate adrenal aldosterone concentrations was 30% and 39%, in the left and right veins, respectively (corresponding to a percentage difference of 57% and 73%), resulting in lateralization discordance in up to 17% of patients if the lateralization index were calculated using only one unstimulated aldosterone-to-cortisol ratio rather than the average of triplicate measures.
Circulating aldosterone levels can reach nadirs conventionally considered incompatible with the primary aldosteronism diagnosis, and adrenal venous aldosterone concentrations exhibit acute variability that can confound AVS interpretation. A single venous aldosterone measurement lacks precision and reproducibility in primary aldosteronism.
醛固酮浓度在原发性醛固酮增多症患者中存在变异性。
我们对在一家三级转诊中心接受肾上腺静脉采样 (AVS) 的 340 例原发性醛固酮增多症患者进行了回顾性队列研究，其中 116 例患者在进行该程序前数小时还测量了外周静脉醛固酮。由同一位介入放射科医生使用双侧同时采样，在非刺激和刺激条件下进行 AVS，每份样本重复采集 3 次。主要观察指标是：(i) AVS 前到 AVS 期间静脉醛固酮的日变化；(ii) AVS 期间重复测量的肾上腺静脉醛固酮浓度的变异性。
在平均 131 分钟的时间内，81%的患者循环醛固酮浓度下降（相对下降 51%，中位数下降 7.0ng/dl）。超过四分之一（26%）的所有患者在开始 AVS 时下腔静脉醛固酮≤5ng/dl。左侧和右侧静脉中重复测量的肾上腺醛固酮浓度的平均值变异系数分别为 30%和 39%（分别对应于 57%和 73%的百分比差异），如果仅使用一个非刺激醛固酮与皮质醇比值计算侧化指数而不是重复测量的平均值，则多达 17%的患者会出现侧化不一致。
循环醛固酮水平可降至传统上认为与原发性醛固酮增多症诊断不兼容的最低点，并且肾上腺静脉醛固酮浓度存在急性变异性，可能会影响 AVS 解读。在原发性醛固酮增多症中，单次静脉醛固酮测量缺乏精确性和可重复性。
