Department of Diabetes and Endocrinology, Sapporo City General Hospital, Sapporo 060-8604, Japan.
Endocr J. 2023 Sep 28;70(9):917-924. doi: 10.1507/endocrj.EJ23-0174. Epub 2023 Jul 8.
Hyperkalemia is developed in a part of patients with aldosterone-producing adenoma (APA) after adrenalectomy, suspected to be due to the insufficiency of aldosterone secretion. The purpose of this study is to determine the frequency and characteristics of prolonged postoperative hypoaldosteronism (PPHA) using chemiluminescent enzyme immunoassay (CLEIA). We studied 58 patients with APA with long time after adrenalectomy and whose PAC was measured using a CLEIA kit. The PAC value measured using CLEIA was significantly lower than that of using RIA between two consecutive visits before and after the shift of measuring method of PAC (median [interquantile range], 123.0 [99.8-164.0] vs. 39.5 [15.8-64.2] pg/mL, p < 0.01). PAC was below the minimum limit of quantification (4.0 pg/mL) of the CLEIA kit at least once in nine patients (15.5%) who had PPHA. The PPHA group were older (mean ± standard deviation, 61.3 ± 8.5 vs. 50.5 ± 10.1 years, p < 0.01) and had lower eGFR (60.3 ± 14.0 vs. 82.3 ± 22.8 mL/min/1.73 m, p < 0.01) than the non-PPHA group. The frequency of postoperative hyperkalemia (maximum serum potassium >5.5 mEq/L) was higher in the PPHA group than in the non-PPHA group (55.6% vs. 8.2%, p < 0.01). In conclusion, a few patients with APA long time after adrenalectomy had unmeasurable PAC using CLEIA. PPHA is likely to develop in patients with APA after adrenalectomy who are older and have impaired renal function. Additionally, PPHA is related to the occurrence of postoperative hyperkalemia.
醛固酮瘤（APA）患者在肾上腺切除术后部分出现高钾血症，推测与醛固酮分泌不足有关。本研究旨在使用化学发光酶免疫分析法（CLEIA）确定术后低醛固酮血症（PPHA）的发生频率和特征。我们研究了 58 例长期肾上腺切除术后的 APA 患者，使用 CLEIA 试剂盒测量其 PAC。在连续两次就诊时，使用 CLEIA 测量的 PAC 值明显低于切换 PAC 测量方法前后的 RIA 值（中位数[四分位间距]，123.0[99.8-164.0]比 39.5[15.8-64.2]pg/mL，p<0.01）。在 9 例（15.5%）至少有一次出现 PPHA 的患者中，PAC 值低于 CLEIA 试剂盒的定量下限（4.0pg/mL）。PPHA 组年龄较大（均数±标准差，61.3±8.5 比 50.5±10.1 岁，p<0.01），eGFR 较低（60.3±14.0 比 82.3±22.8 mL/min/1.73 m，p<0.01）。与非-PPHA 组相比，PPHA 组术后高钾血症（最大血清钾>5.5 mEq/L）的发生率更高（55.6%比 8.2%，p<0.01）。总之，少数长期肾上腺切除术后的 APA 患者使用 CLEIA 无法测量 PAC。PPHA 可能发生在肾上腺切除术后年龄较大且肾功能受损的 APA 患者中。此外，PPHA 与术后高钾血症的发生有关。
