Hung Matthew L, Wachtel Heather, Cohen Debbie L, Fraker Douglas, Trerotola Scott O
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
J Vasc Interv Radiol. 2023 Mar;34(3):474-478. doi: 10.1016/j.jvir.2022.12.003. Epub 2022 Dec 9.
To determine the utility of adrenal vein sampling (AVS) and outcomes after adrenalectomy in patients with normal plasma aldosterone concentration (PAC) and elevated aldosterone-to-renin ratio (ARR).
The study sample included 106 patients with ARR greater than 20 and PAC between 5 and 15 ng/dL (normal PAC group) who underwent AVS from 2005 to 2021. These patients were compared with a cohort of 106 patients with ARR >20 and PAC >15 ng/dL (high PAC group) who underwent AVS during the same period. Data regarding baseline clinical characteristics, lateralization indices from AVS, and outcomes after adrenalectomy were analyzed.
AVS was technically successful in 210 patients (210/212, 99%). A smaller proportion of patients in the normal PAC group showed a lateralization index of >4 compared with those in the high PAC group (44% vs 64%, P <.01). A similar proportion of patients in the normal PAC group experienced improved or cured hypertension after adrenalectomy compared with that in the high PAC group (94% vs 88%, P =.31). Hypokalemia was cured in all patients in the normal PAC group after adrenalectomy compared with 98% of patients in the high PAC group (100% vs 98%, P = 1).
Although lateralization is less frequent for patients with normal PAC, patients who do lateralize show similar blood pressure response and correction of hypokalemia after adrenalectomy, regardless of initial plasma aldosterone levels. Therefore, patients with PAC <15 ng/dL should still be considered for AVS provided the ARR is elevated.
确定肾上腺静脉采血（AVS）在血浆醛固酮浓度（PAC）正常但醛固酮与肾素比值（ARR）升高的患者中的应用价值以及肾上腺切除术后的结局。
研究样本包括2005年至2021年期间接受AVS的106例ARR大于20且PAC在5至15 ng/dL之间的患者（正常PAC组）。将这些患者与同期接受AVS的106例ARR>20且PAC>15 ng/dL的患者队列（高PAC组）进行比较。分析了有关基线临床特征、AVS的侧别指数以及肾上腺切除术后结局的数据。
210例患者（210/212，99%）的AVS技术成功。与高PAC组相比，正常PAC组中侧别指数>4的患者比例较小（44%对64%，P<.01）。与高PAC组相比，正常PAC组中肾上腺切除术后高血压得到改善或治愈的患者比例相似（94%对88%，P =.31）。肾上腺切除术后，正常PAC组的所有患者低钾血症均得到治愈，而高PAC组为98%（100%对98%，P = 1）。
尽管PAC正常的患者侧别化情况较少见，但侧别化的患者在肾上腺切除术后显示出相似的血压反应和低钾血症纠正情况，无论初始血浆醛固酮水平如何。因此，只要ARR升高，PAC<15 ng/dL的患者仍应考虑进行AVS。
