Abstract：
BACKGROUND: Adrenal venous sampling (AVS) is used to distinguish unilateral from bilateral aldosterone hypersecretion as a cause of primary aldosteronism (PA). Unilateral disease is treated with adrenalectomy and bilateral hypersecretion managed medically.
METHODS: We performed a single institution retrospective cohort study of adult patients undergoing adrenalectomy for PA from July 2013 to June 2022. Concordance of imaging findings with AVS was evaluated. Statistical analysis was performed with Mann-Whitney U and chi-squared Fisher\'s exact. Literature review performed via triple method search strategy.
RESULTS: Twenty-one patients underwent AVS and adrenalectomy for PA. Two patients did not have imaging findings and 19 were localized with an adenoma. For patients with image localization, AVS was concordant in nine, discordant in four, and nondiagnostic in six. For patients with discordant findings, age range was 35.8 to 72.4 y compared with concordant patient age range of 49.8 to 71.7 y. Overall discordance between imaging results and AVS was 40%. The aldosterone level was associated with concordance with a median of 52 ng/dL compared with 26 ng/dL if discordant (P = 0.002). There was a significant reduction in antihypertensive medications for the entire cohort from a median of three medications (interquartile range 2-4) to 1 medication (interquartile range 1-2), P < 0.001.
CONCLUSIONS: In this cohort, 40% of patients with selective AVS had discordant imaging and AVS results. Aldosterone level was associated with concordance. Hypertension was significantly improved with a median decrease of two antihypertensives. Our results support performance of AVS on all candidates for adrenalectomy for PA.
METHODS: We performed a single institution retrospective cohort study of adult patients undergoing adrenalectomy for PA from July 2013 to June 2022. Concordance of imaging findings with AVS was evaluated. Statistical analysis was performed with Mann-Whitney U and chi-squared Fisher\'s exact. Literature review performed via triple method search strategy.
RESULTS: Twenty-one patients underwent AVS and adrenalectomy for PA. Two patients did not have imaging findings and 19 were localized with an adenoma. For patients with image localization, AVS was concordant in nine, discordant in four, and nondiagnostic in six. For patients with discordant findings, age range was 35.8 to 72.4 y compared with concordant patient age range of 49.8 to 71.7 y. Overall discordance between imaging results and AVS was 40%. The aldosterone level was associated with concordance with a median of 52 ng/dL compared with 26 ng/dL if discordant (P = 0.002). There was a significant reduction in antihypertensive medications for the entire cohort from a median of three medications (interquartile range 2-4) to 1 medication (interquartile range 1-2), P < 0.001.
CONCLUSIONS: In this cohort, 40% of patients with selective AVS had discordant imaging and AVS results. Aldosterone level was associated with concordance. Hypertension was significantly improved with a median decrease of two antihypertensives. Our results support performance of AVS on all candidates for adrenalectomy for PA.
摘要：
背景：肾上腺静脉采样（AVS）用于区分单侧和双侧醛固酮分泌过多是原发性醛固酮增多症（PA）的原因。单侧疾病采用肾上腺切除术和双侧分泌过多的药物治疗。
方法：我们于2013年7月至2022年6月对接受PA肾上腺切除术的成年患者进行了单机构回顾性队列研究。评估了影像学发现与AVS的一致性。使用Mann-WhitneyU和卡方Fisher精确进行统计分析。通过三重方法搜索策略进行文献综述。
结果：21例患者因PA行AVS和肾上腺切除术。两名患者没有影像学发现，19例患有腺瘤。对于图像定位的患者，AVS在九点是一致的，四个不和谐，六个人中没有诊断。对于发现不一致的患者，年龄范围为35.8~72.4岁,而一致的患者年龄范围为49.8~71.7岁。成像结果与AVS之间的总体不一致率为40%.醛固酮水平与一致性相关，中位数为52ng/dL，如果不一致则为26ng/dL（P=0.002）。整个队列的抗高血压药物从三种药物（四分位数范围2-4）的中位数到一种药物（四分位数范围1-2）的中位数显着减少，P<0.001。
结论：在这个队列中，40％的选择性AVS患者的影像学和AVS结果不一致。醛固酮水平与一致性相关。随着两种抗高血压药的中位减少，高血压得到了显着改善。我们的结果支持AVS在所有PA肾上腺切除术候选人中的表现。
方法：我们于2013年7月至2022年6月对接受PA肾上腺切除术的成年患者进行了单机构回顾性队列研究。评估了影像学发现与AVS的一致性。使用Mann-WhitneyU和卡方Fisher精确进行统计分析。通过三重方法搜索策略进行文献综述。
结果：21例患者因PA行AVS和肾上腺切除术。两名患者没有影像学发现，19例患有腺瘤。对于图像定位的患者，AVS在九点是一致的，四个不和谐，六个人中没有诊断。对于发现不一致的患者，年龄范围为35.8~72.4岁,而一致的患者年龄范围为49.8~71.7岁。成像结果与AVS之间的总体不一致率为40%.醛固酮水平与一致性相关，中位数为52ng/dL，如果不一致则为26ng/dL（P=0.002）。整个队列的抗高血压药物从三种药物（四分位数范围2-4）的中位数到一种药物（四分位数范围1-2）的中位数显着减少，P<0.001。
结论：在这个队列中，40％的选择性AVS患者的影像学和AVS结果不一致。醛固酮水平与一致性相关。随着两种抗高血压药的中位减少，高血压得到了显着改善。我们的结果支持AVS在所有PA肾上腺切除术候选人中的表现。
