基于肾上腺静脉醛固酮未被皮质醇校正的原发性醛固酮增多症患者的手术决策
Surgical decision in patients with primary aldosteronism based on adrenal veins aldosterone not corrected by cortisol.
作者信息
He Furong, Zhang Xizi, Fu Yiyang, Yang Jun, Du Zhipeng, Song Ying, Hu Jinbo, Zhen Qianna, He Yifan, Li Qifu, He Wenwen, Yang Shumin
机构信息
Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Medicine, Monash University, Clayton, Australia.
出版信息
Endocrine. 2025 Sep;89(3):891-900. doi: 10.1007/s12020-025-04246-3. Epub 2025 Jun 9.
BACKGROUND
Cortisol-corrected aldosterone concentration is used to interpret adrenal venous sampling (AVS) results to identify the subtype of primary aldosteronism. Whether AVS could be interpreted using aldosterone without cortisol correction is unclear.
PURPOSE
To evaluate the accuracy of plasma aldosterone concentration (PAC) and aldosterone ratio (PAC of the higher side divided by PAC of the lower side) of the adrenal veins for the diagnosis of unilateral PA (UPA).
METHODS
A retrospective study was conducted in PA patients who underwent bilaterally successful AVS. Area under the receiver operating characteristic curve (AUC), specificity and sensitivity of PAC and aldosterone ratio of adrenal veins in non-stimulated and adrenocorticotropic hormone (ACTH) - stimulated AVS were calculated.
RESULTS
323 patients with UPA and 122 with bilateral PA were included. Under non-ACTH stimulated AVS, AUC of PAC and aldosterone ratio to diagnose UPA were 0.86 (95%CI 0.83-0.89) and 0.84 (95%CI 0.80-0.88), respectively. The specificity was 90%, with sensitivity of 59%, when using PAC cutoff of 1012.8 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 65%, when using aldosterone ratio cutoff of 6.84 to diagnose UPA. Under ACTH stimulated AVS, PAC and aldosterone ratio showed similar accuracy to diagnose UPA. The specificity was 90%, with sensitivity of 60%, when using PAC cutoff of 4008.3 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 80%, when using aldosterone ratio cutoff of 4.77 to diagnose UPA.
CONCLUSION
PAC and aldosterone ratio of the adrenal veins can be used to diagnose UPA during non-stimulated and ACTH-stimulated AVS.
背景
校正皮质醇后的醛固酮浓度用于解读肾上腺静脉采血（AVS）结果，以鉴别原发性醛固酮增多症的亚型。目前尚不清楚是否可以不校正皮质醇而仅使用醛固酮来解读AVS结果。
目的
评估肾上腺静脉血浆醛固酮浓度（PAC）和醛固酮比值（较高侧的PAC除以较低侧的PAC）对诊断单侧原发性醛固酮增多症（UPA）的准确性。
方法
对双侧AVS均成功的PA患者进行一项回顾性研究。计算在非刺激状态和促肾上腺皮质激素（ACTH）刺激的AVS中，肾上腺静脉PAC和醛固酮比值的受试者操作特征曲线下面积（AUC）、特异性和敏感性。
结果
纳入323例UPA患者和122例双侧PA患者。在非ACTH刺激的AVS中，用于诊断UPA的PAC和醛固酮比值的AUC分别为0.86（95%CI 0.83 - 0.89）和0.84（95%CI 0.80 - 0.88）。当使用PAC临界值1012.8 ng/dL诊断UPA时，特异性为90%，敏感性为59%。当使用醛固酮比值临界值6.84诊断UPA时，特异性为90%，敏感性为65%。在ACTH刺激的AVS中，PAC和醛固酮比值对诊断UPA显示出相似的准确性。当使用PAC临界值4008.3 ng/dL诊断UPA时，特异性为90%，敏感性为60%。当使用醛固酮比值临界值4.77诊断UPA时，特异性为90%，敏感性为80%。
结论
在非刺激状态和ACTH刺激的AVS期间，肾上腺静脉的PAC和醛固酮比值可用于诊断UPA。
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