Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, 113-8655, Japan.
Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, 222-0036, Japan.
J Clin Endocrinol Metab. 2022 Nov 23;107(11):3045-3054. doi: 10.1210/clinem/dgac530.
There are inconsistent results and insufficient evidence as to whether an association exists between the size and aldosterone-producing ability of aldosterone-producing adenomas.
We further investigated this possible association retrospectively.
A total of 142 cases of primary aldosteronism diagnosed as unilateral by adrenal venous sampling at 2 referral centers between 2009 and 2019 were included. We classified these individuals into small and large tumor groups using a diameter of 14 mm as a cutoff. This size was the median diameter of the tumor on the affected side of the adrenal gland. We compared plasma aldosterone concentration (PAC), plasma renin activity (PRA), PAC to PRA ratio, PAC from a saline infusion test (SIT), urinary aldosterone secretion (uAld), and serum potassium as indices of aldosterone-producing ability between the 2 groups. In some cases, we conducted histopathological evaluations and detection of the KCNJ5 mutation.
PAC, PAC to PRA ratio, PAC from SIT, and uAld were higher and serum potassium was lower in the large tumor group. PAC, PAC from SIT, uAld, and serum potassium significantly correlated with tumor diameter. PRA was not associated with tumor diameter. Clear cell-dominant cases were more common in the large tumor group, while cases showing a strong expression of CYP11B2 were not significantly different between the groups. KCNJ5 mutations tended to be more common in the large tumor group.
The higher aldosterone-producing ability in larger adenomas can be used to infer the responsible lesion and disease type.
目前对于醛固酮瘤的大小和醛固酮分泌能力之间是否存在关联，结果并不一致，且证据不足。
我们进一步回顾性研究了这种可能的关联。
共纳入 2009 年至 2019 年在 2 家转诊中心通过肾上腺静脉采样诊断为单侧原发性醛固酮增多症的 142 例患者。我们使用 14mm 作为截止值将这些个体分为肿瘤小和肿瘤大两组。该大小为肾上腺受影响侧肿瘤的中位数直径。我们比较了两组之间的血浆醛固酮浓度（PAC）、血浆肾素活性（PRA）、PAC 与 PRA 比值、盐水输注试验（SIT）中的 PAC、尿醛固酮分泌（uAld）和血清钾作为醛固酮分泌能力的指标。在某些情况下，我们进行了组织病理学评估和 KCNJ5 突变的检测。
肿瘤大组的 PAC、PAC 与 PRA 比值、SIT 中的 PAC 和 uAld 更高，血清钾更低。PAC、SIT 中的 PAC、uAld 和血清钾与肿瘤直径显著相关。PRA 与肿瘤直径无关。肿瘤大组中更常见以透明细胞为主的病例，而两组之间 CYP11B2 强表达的病例没有显著差异。KCNJ5 突变在肿瘤大组中更常见。
较大腺瘤中更高的醛固酮分泌能力可用于推断责任病变和疾病类型。
