Ma Meng, Shen Sikui, Abudukerimu Buatikamu, Xie Wei, Zou Mingxi, Chen Ying, Tian Haoming, Ren Yan, Chen Tao
Department of Endocrinology and Metabolism, Adrenal Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, PR China.
Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, PR China.
Medicine (Baltimore). 2025 Jul 25;104(30):e43520. doi: 10.1097/MD.0000000000043520.
Primary aldosteronism can be categorized into 2 main subtypes: aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism. The treatment strategies for these 2 subtypes differ markedly: APA requires surgical removal of the adenoma, whereas idiopathic hyperaldosteronism is managed with pharmacological therapy. Adrenal venous sampling (AVS) is the most widely used technique for diagnosing APA, but its results can be influenced by abnormal adrenal or tumor venous drainage.
A 58-year-old female was admitted due to elevated blood pressure for over 20 years and persistent hypokalemia for 3 months, accompanied by reduced physical strength, nocturia (2-3 times per night, 200-300 mL each time), and poor sleep quality.
The AVS results of the patient did not demonstrate lateralized aldosterone secretion. However, the patient's Kupers and Kobayashi predictive scores, as well as elevated levels of 18-hydroxycortisol and 11-deoxycorticosterone, all supported the presence of a unilateral APA. Retrospective analysis of contrast-enhanced adrenal computed tomography revealed a right adrenal adenoma with a solitary vein draining directly into the inferior vena cava. In addition, 68Ga-pentixafor positron emission tomography/magnetic resonance imaging supported the diagnosis of a right-sided APA.
Right adrenalectomy was performed.
At 1 and 3 months postoperatively, the patient exhibited complete clinical and biochemical remission.
This case highlights that when there is discordance between AVS findings and clinical assessments (e.g., predictive models), a multifaceted approach incorporating predictive scores, 18-hydroxycortisol, 11-deoxycorticosterone levels, and 68Ga-pentixafor positron emission tomography/magnetic resonance imaging can facilitate accurate diagnosis and guide management decisions.
原发性醛固酮增多症可分为2种主要亚型：醛固酮瘤（APA）和特发性醛固酮增多症。这2种亚型的治疗策略显著不同：APA需要手术切除腺瘤，而特发性醛固酮增多症则采用药物治疗。肾上腺静脉采样（AVS）是诊断APA最广泛使用的技术，但其结果可能受到肾上腺或肿瘤静脉引流异常的影响。
一名58岁女性因血压升高20多年、持续性低钾血症3个月入院，伴有体力下降、夜尿（每晚2 - 3次，每次200 - 300毫升）和睡眠质量差。
患者的AVS结果未显示醛固酮分泌的侧别差异。然而，患者的库珀斯和小林预测评分以及18 - 羟皮质醇和11 - 脱氧皮质酮水平升高，均支持存在单侧APA。对增强肾上腺计算机断层扫描的回顾性分析显示右肾上腺腺瘤有一条单独的静脉直接汇入下腔静脉。此外，68Ga - 喷替酸正电子发射断层扫描/磁共振成像支持右侧APA的诊断。
进行了右肾上腺切除术。
术后第1个月和第3个月，患者临床和生化指标完全缓解。
该病例表明，当AVS结果与临床评估（如预测模型）不一致时，采用包括预测评分、18 - 羟皮质醇、11 - 脱氧皮质酮水平以及68Ga - 喷替酸正电子发射断层扫描/磁共振成像在内的多方面方法，有助于准确诊断并指导管理决策。
