Computed Tomography and Adrenal Venous Sampling in the Diagnosis of Unilateral Primary Aldosteronism.

Autor: Williams TA; From the Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Germany (T.A.W., C.A., F.B., D.A.H., M.R.).; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy (T.A.W., J.B., P.M.)., Burrello J; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy (T.A.W., J.B., P.M.)., Sechi LA; Hypertension Unit, Internal Medicine, Department of Medicine (DAME), University of Udine, Italy (L.A.S., C.C.)., Fardella CE; Departamento Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago (C.E.F., R.B.)., Matrozova J; Clinical Centre of Endocrinology, Medical University, Sofia, Bulgaria (J.M.)., Adolf C; From the Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Germany (T.A.W., C.A., F.B., D.A.H., M.R.)., Baudrand R; Departamento Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago (C.E.F., R.B.)., Bernardi S; Department of Medical Sciences, University of Trieste, Italy (S.B.).; ASUITS-Azienda Sanitaria Universitaria Integrata di Trieste, Cattinara Teaching Hospital, Italy (S.B.)., Beuschlein F; From the Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Germany (T.A.W., C.A., F.B., D.A.H., M.R.).; Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Universitätsspital Zürich, Switzerland (F.B.)., Catena C; Hypertension Unit, Internal Medicine, Department of Medicine (DAME), University of Udine, Italy (L.A.S., C.C.)., Doumas M; 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece (M.D.)., Fallo F; Department of Medicine (DIMED), University of Padova, Italy (F.F.)., Giacchetti G; Division of Endocrinology, Polytechnic University of Marche, Ancona, Italy (G.G.)., Heinrich DA; From the Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Germany (T.A.W., C.A., F.B., D.A.H., M.R.)., Saint-Hilary G; Dipartimento di Scienze Matematiche (DISMA), Giuseppe Luigi Lagrange, Politecnico di Torino, Italy (G.S.-H.)., Jansen PM; Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia (P.M.J., M.S.)., Januszewicz A; Department of Hypertension, Institute of Cardiology, Warsaw, Poland (A.J.)., Kocjan T; Department of Endocrinology, Diabetes and Metabolic diseases, University Medical Centre, Ljubljana, Slovenia (T.K.)., Nishikawa T; Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Japan (T.N.)., Quinkler M; Endocrinology in Charlottenburg, Berlin, Germany (M.Q.)., Satoh F; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Japan (F.S.)., Umakoshi H; Department of Endocrinology, Metabolism and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Japan (H.U.)., Widimský J Jr; 3rd Department of Medicine, Center for Hypertension, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic (J.W.)., Hahner S; Department of Internal Medicine I, Endocrinology and Diabetes Unit, University Hospital of Würzburg, University of Würzburg, Germany (S.H.)., Douma S; 3rd Department of Internal Medicine, Aristotle University, Thessaloniki, Greece (S.D.)., Stowasser M; Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, Australia (P.M.J., M.S.)., Mulatero P; Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Italy (T.A.W., J.B., P.M.)., Reincke M; From the Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Germany (T.A.W., C.A., F.B., D.A.H., M.R.).
Jazyk: angličtina
Zdroj: Hypertension (Dallas, Tex. : 1979) [Hypertension] 2018 Sep; Vol. 72 (3), pp. 641-649.
DOI: 10.1161/HYPERTENSIONAHA.118.11382
Abstrakt: Unilateral primary aldosteronism is the most common surgically correctable form of endocrine hypertension and is usually differentiated from bilateral forms by adrenal venous sampling (AVS) or computed tomography (CT). Our objective was to compare clinical and biochemical postsurgical outcomes of patients with unilateral primary aldosteronism diagnosed by CT or AVS and identify predictors of surgical outcomes. Patient data were obtained from 18 internationally distributed centers and retrospectively analyzed for clinical and biochemical outcomes of adrenalectomy of patients with surgical management based on CT (n=235 patients, diagnosed from 1994-2016) or AVS (526 patients, diagnosed from 1994-2015) using the standardized PASO (Primary Aldosteronism Surgical Outcome) criteria. Biochemical outcomes were highly different according to surgical management approach with a smaller proportion in the CT group achieving complete biochemical success (188 of 235 [80%] patients versus 491 of 526 [93%], P<0.001) and a greater proportion with absent biochemical success (29 of 235 [12%] versus 10 of 526 [2%], P<0.001). A diagnosis by CT was associated with a decreased likelihood of complete biochemical success compared with AVS (odds ratio, 0.28; 0.16-0.50; P<0.001). Clinical outcomes were not significantly different, but the absence of a postsurgical elevated aldosterone-to-renin ratio was a strong marker of complete clinical success (odds ratio, 14.81; 1.76-124.53; P=0.013) in the CT but not in the AVS group. In conclusion, patients diagnosed by CT have a decreased likelihood of achieving complete biochemical success compared with a diagnosis by AVS.
Databáze: MEDLINE