Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden.
The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Clin Endocrinol Metab. 2021 Apr 23;106(5):e2087-e2095. doi: 10.1210/clinem/dgab047.
Current clinical guidelines suggest that adrenal venous sampling (AVS) may not be mandatory in young patients with primary aldosteronism (PA) and a solitary adrenal adenoma on imaging.
The aim of this study was to further elucidate whether conventional imaging alone is sufficient to distinguish unilateral from bilateral PA among patients aged 40 years or younger.
This was a retrospective study where data from 45 patients with PA, aged between 26 and 40 years, who underwent successful AVS between 2005 and 2019, were analyzed. Results concerning laterality on imaging studies and AVS were recorded. Outcome in surgically treated patients was assessed according to the Primary Aldosteronism Surgical Outcomes criteria.
In 4 of 25 patients with unilateral aldosterone production according to AVS, computed tomography inaccurately suggested bilateral disease. Following unilateral adrenalectomy, all 4 patients showed complete clinical success. Five of 20 patients with bilateral aldosterone production according to AVS had a solitary adrenal nodule (8-19 mm) on imaging. Two of these 5 patients were treated with unilateral adrenalectomy, neither having complete biochemical and/or clinical success postoperatively. Two of 16 patients younger than 35 years had discordant results, 1 with unilateral and 1 with bilateral aldosterone production, according to AVS.
Imaging studies inaccurately predicted laterality in a significant number of young patients with PA. In contrast to current clinical guidelines, our results support AVS for subtype evaluation in young adults with PA, including patients 35 years or younger.
目前的临床指南表明，对于影像学检查发现单侧肾上腺腺瘤的年轻原发性醛固酮增多症（PA）患者，肾上腺静脉采样（AVS）可能不是必需的。
本研究旨在进一步阐明，对于 40 岁及以下的患者，单纯常规影像学检查是否足以区分单侧和双侧 PA。
这是一项回顾性研究，分析了 2005 年至 2019 年间成功进行 AVS 的 45 例年龄在 26 至 40 岁之间的 PA 患者的数据。记录了影像学研究和 AVS 对侧别的结果。根据原发性醛固酮增多症手术治疗结果标准评估手术治疗患者的结果。
在根据 AVS 单侧醛固酮生成的 25 例患者中，有 4 例 CT 不准确地提示双侧疾病。在单侧肾上腺切除术之后，这 4 例患者均完全临床治愈。在根据 AVS 双侧醛固酮生成的 20 例患者中，有 5 例影像学检查有单侧肾上腺结节（8-19mm）。这 5 例患者中有 2 例接受了单侧肾上腺切除术，但术后均无完全生化和/或临床治愈。在 16 例年龄小于 35 岁的患者中，有 2 例根据 AVS 结果存在不一致的结果，1 例单侧，1 例双侧醛固酮生成。
影像学检查在很大一部分年轻的 PA 患者中对侧别预测不准确。与目前的临床指南相反，我们的结果支持在年轻的 PA 成年患者（包括 35 岁或以下的患者）中进行 AVS 以评估亚型。
