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- 저자 : Masakatsu Sone (검색결과 1 건)
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Adrenal Venous Sampling for Subtype Diagnosis of Primary Hyperaldosteronism
Mitsuhide Naruse,Akiyo Tanabe,Koichi Yamamoto,Hiromi Rakugi,Mitsuhiro Kometani,Takashi Yoneda,Hiroki Kobayashi,Masanori Abe,Youichi Ohno,Nobuya Inagaki,Shoichiro Izawa,Masakatsu Sone 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.5
Adrenal venous sampling (AVS) is the key procedure for lateralization of primary hyperaldosteronism (PA) before surgery. Identification of the adrenal veins using computed tomography (CT) and intraoperative cortisol assay facilitates the success of catheterization. Although administration of adrenocorticotropic hormone (ACTH) has benefits such as improving the success rate, some unilateral cases could be falsely diagnosed as bilateral. Selectivity index of 5 with ACTH stimulation to assess the selectivity of catheterization and lateralization index (LI) >4 with ACTH stimulation for unilateral diagnosis is used in many centers. Co-secretion of cortisol from the tumor potentially affects the lateralization by the LI. Patients aged <35 years with hypokalemia, marked aldosteroneexcess, and unilateral adrenal nodule on CT have a higher probability of unilateral disease. Patients with normokalemia, mild aldosterone excess, and no adrenal tumor on CT have a higher probability of bilateral disease. Although no methods have 100% specificity for subtype diagnosis that would allow bypassing AVS, prediction of the subtype should be considered when recommending AVSto patients. Methodological standardization and strict indication improve diagnostic quality of AVS. Development of non-invasiveimaging and biochemical markers will drive a paradigm shift in the clinical practice of PA.
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