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肾上腺静脉采血是近年来在我国兴起的一项新技术,本文通过不同方案,采用不同的参数及切点,分析其在原发性醛固酮增多症分型诊断中的敏感性和特异性,并与肾上腺计算机断层扫描(CT)等手段相比较,阐明其在分型诊断中的地位和价值。 相似文献
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肾上腺静脉插管取血在原发性醛固酮增多症分型诊断中的意义 总被引:7,自引:3,他引:7
目的 探讨肾上腺静脉插管检查在原发性醛固酮增多症 (原醛 )分型诊断中的应用价值。方法 临床 14例明确为原醛患者 ( 11例腺瘤及 3例增生 )经肾上腺静脉插管检查 ,取双侧肾上腺静脉以及肾静脉水平下的下腔静脉采血 ,测各点醛固酮和皮质醇水平 ,并将结果与影像学检查及术后病理结果进行比较。结果 腺瘤患者插管结果与影像学检查及术后病理结果无统计学差异 ,符合率为 81 82 % ( 9/ 11) ,3例增生患者插管结果与影像学检查结果均相符。结论 肾上腺静脉插管检查在原醛的分型诊断中有较好的准确性 ,是影像学检查有疑问时可选择的良好方法。 相似文献
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Scoring system for the diagnosis of bilateral primary aldosteronism in the outpatient setting before adrenal venous sampling 下载免费PDF全文
Hiroki Kobayashi Akira Haketa Takahiro Ueno Yukihiro Ikeda Yoshinari Hatanaka Sho Tanaka Hiromasa Otsuka Masanori Abe Noboru Fukuda Masayoshi Soma 《Clinical endocrinology》2017,86(4):467-472
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Murashima M Trerotola SO Fraker DL Han D Townsend RR Cohen DL 《Journal of human hypertension》2009,23(4):292-294
We report six patients with primary aldosteronism who had serial adrenal venous sampling. Patients with contralateral suppression of aldosterone to cortisol ratio compared with that in inferior vena cava developed lateralization over time whereas patients without contralateral suppression remained with a bilateral pattern. 相似文献
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This retrospective study was aimed 1) to compare the difference of the findings between adrenal CT scan and adrenal venous sampling (AVS) in 35 cases with definite primary aldosteronism (PA) for assessment of the diagnostic efficacy of PA subgroup (unilateral and bilateral adrenal hypersecretion: UAH and BAH), and 2) to determine the clinical and biochemical parameters as potential predictors for PA subgroup. There were significant discordant results based on AVS and CT scan in subgrouping PA; 9 of 17 BAH patients (53%) had unilateral lesion on CT scan, while 4 of 18 UAH patients (22%) had no apparent or bilateral lesions on CT scan. Among three diagnostic criteria, absolute values of plasma aldosterone concentration (PAC) in both adrenal veins, lateralized and contralateral ratios of aldosterone/cortisol after ACTH stimulation during AVS to determine the laterality, none of them showed 100% diagnostic accuracy if applied alone. Among several clinical and biochemical parameters, hypokalemia (<3.4 mEq/l), younger age (<52 y) and poor response of PAC (<1.45) after furosemide-upright posture, proved to be significant predictors for UAH, with higher specificities (100%, 88%, 94%, respectively). Therefore, despite AVS as a gold standard method to determine the laterality of aldosterone hypersecretion in PA, our study shows that no single criterion could provide definite diagnostic value for its laterality by AVS. It is also suggested that most PA patients, if not all, with a distinct unilateral adrenal lesion on CT accompanied by hypokalemia, younger age and poor aldosterone response to renin stimulation, could undergo adrenalectomy without prior AVS. 相似文献
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Auchus RJ Chandler DW Singeetham S Chokshi N Nwariaku FE Dolmatch BL Holt SA Wians FH Josephs SC Trimmer CK Lopera J Vongpatanasin W Nesbitt SD Leonard D Victor RG 《The Journal of clinical endocrinology and metabolism》2007,92(7):2648-2651
CONTEXT: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. OBJECTIVES: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. DESIGN, SETTING, AND SUBJECTS: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. MAIN OUTCOME MEASURES: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. RESULTS: The 18OHB/A ratios were much lower in blood draining APAs (2.17 +/- 0.62) than in blood draining the contralateral adrenals (12.96 +/- 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 +/- 4.32; P = 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 +/- 11.51) compared with IHA adrenals (9.22 +/- 5.18; P < 0.001) or the contralateral adrenals (6.23 +/- 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. CONCLUSIONS: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS. 相似文献
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Rossi GP 《Current hypertension reports》2007,9(2):90-97
Improved diagnostic techniques and adoption of a systematic and thorough diagnostic workup can lead to identification of the
surgically correctable forms of primary aldosteronism (PA) far more frequently than expected. Adrenalectomy can provide long-term
normalization of blood pressure and correction of PA in most patients with an aldosterone-producing adenoma. Forms needing
surgical correction are generally held to be less common than forms requiring medical therapy; however, this can be a misconception
arising from the lack of systematic use of adrenal vein sampling (AVS). Currently AVS still remains the “gold standard” for
identifying unilateral causes of PA that are surgically curable. The criteria for selecting patients to undergo AVS, the technique
for performing AVS, and the criteria for analyzing and interpreting its results are summarized here. 相似文献
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Optimum position of left adrenal vein sampling for subtype diagnosis in primary aldosteronism 下载免费PDF全文
Hironobu Umakoshi Norio Wada Takamasa Ichijo Kohei Kamemura Yuichi Matsuda Yuichi Fuji Tatsuya Kai Tomikazu Fukuoka Ryuichi Sakamoto Atsushi Ogo Tomoko Suzuki Mika Tsuiki Mitsuhide Naruse WAVES‐J Study Group 《Clinical endocrinology》2015,83(6):768-773
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Kenichi Yamahara Hiroshi Itoh Akira Yamamoto Hironobu Sasano Ken Masatsugu Naoki Sawada Yasutomo Fukunaga Satsuki Sakaguchi Masakatsu Sone Takami Yurugi Kazuwa Nakao 《Hypertension research》2002,25(2):145-152
Formerly, the incidence of primary aldosteronism (PA) among patients with hypertension was believed to be less than 1%. However, recent studies have suggested a much higher incidence of 6.59%-14.4% among such patients. These findings suggest that many cases of PA caused by small aldosterone-producing adenoma (APA) or idiopathic hyperaldosteronism (IHA) have not been properly diagnosed. To make a more accurate diagnosis in such cases, we developed a new diagnostic procedure for localization of PA, namely, adrenal venous sampling under continuous infusion of adrenocorticotropic hormone (ACTH) and administration of angiotensin II receptor blocker (AVS with ACTH and ARB). Here, we confirm the efficacy of this procedure in the case of a 37-year-old male suspected of having PA. The anticipated diagnosis of PA was based on the presence of hypokalemia, low plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC) and left adrenal mass. However, AVS with ACTH and ARB revealed the presence of bilateral multiple adrenal microadenomas. In the new AVS method, neither ACTH nor the renin-angiotensin system (RAS) exert any influence on the plasma aldosterone level, and a more accurate aldosterone secretary state and a more accurate assessment of the aldosterone secretion of both adrenal glands can be recognized than by conventional AVS. Use of this new method should enable identification of additional cases of APA among patients diagnosed with essential hypertension. 相似文献
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Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism 总被引:28,自引:0,他引:28
Magill SB Raff H Shaker JL Brickner RC Knechtges TE Kehoe ME Findling JW 《The Journal of clinical endocrinology and metabolism》2001,86(3):1066-1071
Determination of the etiology of primary aldosteronism remains a diagnostic challenge. The most common types of primary aldosteronism are bilateral adrenal hyperplasia (BAH), aldosterone-producing adenomas (APA), and primary adrenal hyperplasia. Computed tomography (CT) and adrenal vein sampling (AVS) are the primary modalities used to differentiate these subtypes. The purpose of this study was to compare AVS and CT imaging of the adrenal glands in patients with hyperaldosteronism in whom CT imaging was normal or in whom focal unilateral or bilateral adrenal abnormalities were detected. The diagnosis of primary aldosteronism was made in 62 patients based on an elevated plasma aldosterone to PRA ratio and an elevated urinary aldosterone excretion rate. Thirty-eight patients had CT imaging and successful bilateral adrenal vein sampling and were included in the final analysis. AVS was considered the gold standard in determining the specific subtype of primary aldosteronism. There were 15 patients with APA, 21 patients with BAH, and 2 patients with primary adrenal hyperplasia. Plasma aldosterone was significantly higher in patients with APA (46.3 +/- 8.5 ng/dL; 1284 +/- 235 pmol/L) than in those with BAH (29.3 +/- 2.4 ng/dL; 813 +/- 11 pmol/L; P < 0.05). Plasma potassium was significantly lower in patients with APA (3.1 +/- 0.1 mmol/L) than in patients with BAH (3.5 +/- 0.1 mmol/L; P < 0.02). There was considerable overlap in the other biochemical indices (e.g. PRA and urinary aldosterone) in patients with the different subtypes. In patients with APA proven by AVS, eight had concordant findings with CT imaging, four had discordant findings, and three had normal CT imaging. In patients with BAH proven by AVS, four had concordant findings with CT imaging, eight had discordant findings, and nine had normal CT imaging. Compared with AVS, CT imaging was either inaccurate or provided no additional information in 68% of the patients with primary aldosteronism. We conclude that adrenal CT imaging is not a reliable method to differentiate primary aldosteronism. Adrenal vein sampling is essential to establish the correct diagnosis of primary aldosteronism. 相似文献
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Importance of contralateral aldosterone suppression during adrenal vein sampling in the subtype evaluation of primary aldosteronism 下载免费PDF全文
Hironobu Umakoshi Kanako Tanase‐Nakao Norio Wada Takamasa Ichijo Masakatsu Sone Nobuya Inagaki Takuyuki Katabami Kohei Kamemura Yuichi Matsuda Yuichi Fujii Tatsuya Kai Tomikazu Fukuoka Ryuichi Sakamoto Atsushi Ogo Tomoko Suzuki Mika Tsuiki Akira Shimatsu Mitsuhide Naruse 《Clinical endocrinology》2015,83(4):462-467
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Nobushige Oda Yoshiyu Takeda Aoshuang Zhu Mikiya Usukura Takashi Yoneda Hiroyuki Takata Hiroshi Mabuchi 《Hypertension research》2006,29(1):9-14
The mechanism of overproduction of aldosterone in primary aldosteronism is unclear. The intraadrenal renin-angiotensin system (RAS) has been suggested to possess the functional role of the synthesizing aldosterone and regulating blood pressure. In order to clarify the pathophysiological roles of adrenal RAS in aldosterone-producing adenoma (APA), we studied the expressions of the messenger RNAs (mRNAs) of renin, angiotensinogen, type 1 (AT1R) and type 2 angiotensin II receptor (AT2R), CYP11B1 (11 beta-hydroxylase gene) and CYP11B2 (aldosterone synthase gene) in 8 patients with angiotensin II-responsive (ATII-R) APA and compared them with the expressions of the same mRNAs in 8 patients with angiotensin II-unresponsive (ATII-U) APA. Quantification of the mRNA of each gene was done using a real-time polymerase chain reaction with specific primers. There were no significant differences between ATII-R APA and ATII-U APA in the mRNA levels of renin, angiotensinogen, AT1 R, CYP11B1 and CYP11B2. The amount of AT2R mRNA was significantly higher in the patients with ATII-R APA than in those with ATII-U APA (p<0.05). These results may suggest that AT2R partially contributes to the overproduction of aldosterone in ATII-R APA. 相似文献