原发性醛固酮增多症
医学
肾上腺切除术
醛固酮
接收机工作特性
内科学
促肾上腺皮质激素
腺瘤
醛固酮增多症
置信区间
回顾性队列研究
内分泌学
泌尿科
胃肠病学
激素
作者
Denise Bruedgam,Christian Adolf,Holger Schneider,Paul Schwarzlmueller,Lisa Mueller,Laura Handgriff,Martin Bidlingmaier,Sonja Kunz,Petra Zimmermann,Sinan Deniz,Tracy Ann Williams,Felix Beuschlein,Martín Reincke,Daniel A. Heinrich
出处
期刊:European journal of endocrinology
[Bioscientifica]
日期:2023-12-01
卷期号:189 (6): 611-618
标识
DOI:10.1093/ejendo/lvad159
摘要
Primary aldosteronism (PA) is the most common surgically curable cause of hypertension. Unilateral aldosterone-producing adenoma can be treated with adrenalectomy. Clinical and biochemical outcomes are assessed 6-12 months after adrenalectomy according to primary aldosteronism surgical outcome (PASO) consensus criteria. Earlier prediction of biochemical remission would be desirable as it could reduce cumbersome follow-up visits. We hypothesized that postoperative adrenocorticotropic hormone (ACTH) stimulated plasma aldosterone concentrations (PAC) measured shortly after adrenalectomy can predict PASO outcomes.Retrospective cohort study.We analyzed 100 patients of the German Conn's registry who underwent adrenalectomy and postoperative ACTH stimulation tests within the first week after adrenalectomy. Six to twelve months after adrenalectomy we assessed clinical and biochemical outcomes according to PASO criteria. Serum cortisol and PAC were measured by immunoassay at baseline and 30 min after the intravenous ACTH infusion. We used receiver operating characteristics (ROC) curve analysis and matched the parameters to PASO outcomes.Eighty-one percent of patients had complete, 13% partial, and 6% absent biochemical remission. Complete clinical remission was observed in 28%. For a cut-off of 58.5 pg/mL, stimulated PAC could predict partial/absent biochemical remission with a high sensitivity (95%) and reasonable specificity (74%). Stimulated PAC's area under the curve (AUC) (0.89; confidence interval (CI) 0.82-0.96) was significantly higher than other investigated parameters.Low postoperative ACTH stimulated PAC was predictive of biochemical remission. If confirmed, this approach could reduce follow-up visits to assess biochemical outcome.
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