根据年龄预测原发性醛固酮增多症亚型的计算机断层扫描诊断准确性。
Diagnostic Accuracy of Computed Tomography in Predicting Primary Aldosteronism Subtype According to Age.
机构信息
Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Endocrinol Metab (Seoul). 2021 Apr;36(2):401-412. doi: 10.3803/EnM.2020.901. Epub 2021 Mar 31.
BACKGROUND
Guidelines by the Endocrine Society Guideline on bypassing adrenal vein sampling (AVS) in patients <35 years old with marked primary aldosteronism (PA) (hypokalemia and elevated plasma aldosterone concentration [PAC]) and a unilateral lesion on computed tomography (CT) are based on limited number of studies. We aimed to determine the accuracy of CT in PA patients according to age.
METHODS
In this retrospective study, we investigated the concordance between CT and AVS in 466 PA patients from two tertiary centers who successfully underwent AVS.
RESULTS
CT had an overall accuracy of 64.4% (300/466). In the group with unilateral lesion, patients with hypokalemia had higher concordance than those without hypokalemia (85.0% vs. 43.6%, P<0.001). In the group with marked PA (hypokalemia and PAC >15.9 ng/dL) and unilateral lesion, accuracy of CT was 84.6% (11/13) in patients aged <35 years; 100.0% (20/20), aged 35 to 39 years; 89.4% (59/66), aged 40 to 49 years; and 79.8% (79/99), aged ≥50 years. Cut-off age and PAC for concordance was <50 years and >29.6 ng/dL, respectively. The significant difference in accuracy of CT in 198 patients with marked PA and a unilateral lesion between the <50-year age group and ≥50-year age group (90.9% vs. 79.8%, P=0.044) disappeared in 139 of 198 patients with PAC > 30.0 ng/dL (91.9% vs. 87.7%, P=0.590).
CONCLUSION
Patients with hypokalemia, PAC >30.0 ng/dL, and unilateral lesion were at high risk of unilateral PA regardless of age.
背景
内分泌学会指南建议，对于血钾降低和血浆醛固酮浓度[PAC]升高且 CT 单侧有病变的 35 岁以下、单侧醛固酮增多症（PA）显著的患者，可绕过肾上腺静脉采样（AVS）。但是，这些指南是基于有限数量的研究制定的。我们旨在根据年龄确定 CT 在 PA 患者中的准确性。
方法
在这项回顾性研究中，我们调查了来自两个三级中心的 466 例成功进行 AVS 的 PA 患者的 CT 和 AVS 的一致性。
结果
CT 的总体准确性为 64.4%（300/466）。在单侧病变组中，低钾血症患者的一致性高于无低钾血症患者（85.0% vs. 43.6%，P<0.001）。在低钾血症和 PAC>15.9ng/dL 的显著 PA（PA）且单侧病变组中，年龄<35 岁的患者 CT 准确性为 84.6%（11/13）；35-39 岁的患者为 100.0%（20/20）；40-49 岁的患者为 89.4%（59/66）；≥50 岁的患者为 79.8%（79/99）。CT 一致性的临界年龄和 PAC 分别为<50 岁和>29.6ng/dL。在 198 例低钾血症和单侧病变且单侧病变的显著 PA 患者中，<50 岁年龄组和≥50 岁年龄组的 CT 准确性差异有统计学意义（90.9% vs. 79.8%，P=0.044），但在 139 例 PAC>30.0ng/dL 的患者中差异无统计学意义（91.9% vs. 87.7%，P=0.590）。
结论
无论年龄大小，低钾血症、PAC>30.0ng/dL 和单侧病变的患者均存在单侧 PA 的高风险。
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