Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Clin Hypertens (Greenwich). 2023 Nov;25(11):1001-1008. doi: 10.1111/jch.14725. Epub 2023 Oct 4.
Primary aldosteronism (PA) with unilateral adrenal disease can be cured or improved by adrenalectomy. Adrenal venous sampling (AVS) is recommended to identify patients for surgical management. However, surgeries based on computed tomography (CT) images are only advocated for PA patients aged <35 with visible unilateral adenoma. Herein, we aimed to compare CT-based and AVS-based surgery outcomes for PA patients with visible unilateral adenomas for different age groups. A total of 178 PA patients who underwent unilateral adrenalectomy between June 2018 and January 2021 were included in the study based on CT (n = 54) or AVS (n = 124). Demographics, diagnostics, and follow-up data were retrospectively collected. Clinical and biochemical outcomes were analyzed according to Primary Aldosteronism Surgical Outcome (PASO) criteria at 1-year follow-up. Our results showed that complete clinical success (46.3% vs. 47.6%, p = 0.875) and complete biochemical success (88.8% vs. 91.9%, p = 0.515) were similar between the two groups. Age stratification revealed that patients >55 years old were likely to have worse biochemical outcomes; however, these were still not significantly different (21.4% vs. 8.6%, p = 0.220). Of the 114 AVS-based patients who achieved complete biochemical success, 37 (32.4%) with bilateral normal or bilateral abnormal CT images changed treatment options according to AVS results, 1 (0.9%) avoided adrenalectomy on the wrong side. Our results indicated that surgery based on CT images might be feasible for highly selected PA patients with visible unilateral adenomas and less limited by age, while for those with normal adrenal or bilateral adrenal lesions, treatment strategy must be decided by AVS.
原发性醛固酮增多症（PA）伴单侧肾上腺疾病可通过肾上腺切除术治愈或改善。建议进行肾上腺静脉采样（AVS）以确定手术治疗的患者。然而，仅主张对年龄<35 岁且单侧腺瘤可见的 PA 患者进行基于 CT 图像的手术。在此，我们旨在比较 CT 与 AVS 指导下手术治疗单侧可见腺瘤的不同年龄组 PA 患者的结局。共有 178 名于 2018 年 6 月至 2021 年 1 月间因单侧肾上腺切除术就诊的 PA 患者根据 CT（n=54）或 AVS（n=124）纳入本研究。回顾性收集患者的人口统计学、诊断和随访数据。根据 1 年随访时的原发性醛固酮增多症手术结局（PASO）标准分析临床和生化结局。结果显示，两组间完全临床缓解率（46.3%vs.47.6%，p=0.875）和完全生化缓解率（88.8%vs.91.9%，p=0.515）相似。年龄分层显示，年龄>55 岁的患者生化结局更差，但差异无统计学意义（21.4%vs.8.6%，p=0.220）。114 例 AVS 指导下完全生化缓解的患者中，37 例（32.4%）双侧正常或双侧异常 CT 图像患者根据 AVS 结果改变治疗方案，1 例（0.9%）避免了对侧肾上腺切除术。结果表明，对于单侧可见腺瘤且年龄限制较小的高度选择的 PA 患者，基于 CT 图像的手术可能是可行的，而对于肾上腺正常或双侧肾上腺病变的患者，治疗策略必须由 AVS 决定。
