From the Division of Endocrinology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.
Division of General Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.
Endocr Pract. 2020 Sep;26(9):953-959. doi: 10.4158/EP-2019-0599.
Guidelines recommend withdrawing mineralocorticoid-receptor antagonists (MRAs) for 4 weeks prior to adrenal vein sampling (AVS), but this is not always feasible because of hypertension and hypokalemia. This retrospective study of primary aldosteronism (PA) patients who underwent AVS between 2008 and 2018 assessed the effect of continuing MRA on the AVS procedure.
Clinical data including antihypertensive regimen defined by the World Health Organization Daily Defined Dose (DDD) system were collected for 19 patients with adequate cannulation and lateralization during AVS. Results were compared between 5 patients who continued and 14 patients who discontinued MRA therapy (MRA and non-MRA groups).
At diagnosis, plasma renin activity, plasma aldosterone concentration (PAC), potassium (K) doses, and DDD were not significantly different between groups. Aldosterone-renin ratio was significantly higher in the MRA group (median, 375.0; interquartile range [IQR], 224.8 to 544.3 vs. 148.7, 118.4 to 192.1; P = .034). No difference was found in lateralization index (median 48.3; IQR, 23.6 to 52.1 vs. 8.7; 4.9 to 20.2; P = .10). Contralateral suppression, defined as aldosterone-cortisol ratio of unaffected adrenal to periphery, trended lower in the MRA group (median, 0.17; IQR, 0.03 to 0.39 vs. 0.51; 0.27 to 1.1; P = .056). All five MRA patients underwent successful adrenalectomy with at least 50% reduction in DDD and PAC and normal K postoperatively. One MRA patient did not lateralize, which was confirmed on repeat AVS, after MRA withdrawal.
Continuation of MRA may not interfere with AVS lateralization or affect contralateral adrenal suppression. Continuation of MRA in preparation for AVS may be considered, especially in patients with severe PA, to avoid uncontrolled hypertension and severe hypokalemia.
指南建议在进行肾上腺静脉采样（AVS）前停用盐皮质激素受体拮抗剂（MRA）4 周，但由于高血压和低钾血症，这并不总是可行的。本项回顾性研究纳入了 2008 年至 2018 年间接受 AVS 的原发性醛固酮增多症（PA）患者，评估了在 AVS 过程中继续使用 MRA 的效果。
收集了 19 例 AVS 期间导管插管和侧化充分的患者的临床数据，这些数据由世界卫生组织每日定义剂量（DDD）系统定义的降压方案组成。比较了继续使用 MRA 治疗的 5 例患者和停用 MRA 治疗的 14 例患者（MRA 组和非 MRA 组）的结果。
在诊断时，MRA 组的血浆肾素活性、血浆醛固酮浓度（PAC）、钾（K）剂量和 DDD 无显著差异。MRA 组的醛固酮/肾素比值显著更高（中位数，375.0；四分位距[IQR]，224.8 至 544.3 与 148.7，118.4 至 192.1；P=0.034）。侧化指数无差异（中位数 48.3；IQR，23.6 至 52.1 与 8.7；4.9 至 20.2；P=0.10）。未受影响的肾上腺与外周的醛固酮/皮质醇比值（定义为对侧抑制）在 MRA 组中呈下降趋势（中位数，0.17；IQR，0.03 至 0.39 与 0.51；0.27 至 1.1；P=0.056）。所有 5 例 MRA 患者均成功接受了肾上腺切除术，术后 DDD 和 PAC 降低至少 50%，K 正常。1 例 MRA 患者未出现侧化，在 MRA 停药后重复 AVS 时得到了证实。
继续使用 MRA 可能不会干扰 AVS 侧化或影响对侧肾上腺抑制。在准备 AVS 时继续使用 MRA 可能是可行的，特别是在患有严重 PA 的患者中，以避免不受控制的高血压和严重低钾血症。
