医学
同辛托品
原发性醛固酮增多症
肾上腺切除术
回顾性队列研究
优势比
肾上腺皮质腺瘤
队列
外科
醛固酮
泌尿科
内科学
腺瘤
促肾上腺皮质激素
激素
作者
Adina F Turcu,Yuta Tezuka,Jung Soo Lim,Zara Salman,Kartik Sehgal,Haiping Li,Stéphanie Larose,Wasita Warachit Parksook,Tracy Ann Williams,Debbie L. Cohen,Heather Wachtel,Jinghong Zhang,Pranav Dorwal,Fumitoshi Satoh,Jun Yang,André Lacroix,Martín Reincke,Thomas J. Giordano,Aaron M. Udager,Anand Vaidya,William E. Rainey
出处
期刊:Hypertension
[Ovid Technologies (Wolters Kluwer)]
日期:2024-01-04
标识
DOI:10.1161/hypertensionaha.123.21910
摘要
BACKGROUND: Primary aldosteronism (PA) has been broadly dichotomized into unilateral and bilateral forms. Adrenal vein sampling (AVS) lateralization indices (LI) ≥2 to 4 are the standard-of-care to recommend unilateral adrenalectomy for presumed unilateral PA. We aimed to assess the rates and characteristics of residual PA after AVS-guided adrenalectomy. METHODS: We conducted an international, retrospective, cohort study of patients with PA from 7 referral centers who underwent unilateral adrenalectomy based on LI≥4 on baseline and/or cosyntropin-stimulated AVS. Aldosterone synthase (CYP11B2) immunohistochemistry and next generation sequencing were performed on available formalin-fixed paraffin-embedded adrenal tissue. RESULTS: The cohort included 283 patients who underwent AVS-guided adrenalectomy, followed for a median of 326 days postoperatively. Lack of PA cure was observed in 16% of consecutive patients, and in 22 patients with lateralized PA on both baseline and cosyntropin-stimulated AVS. Among patients with residual PA postoperatively, 73% had multiple CYP11B2 positive areas within the resected adrenal tissue (versus 23% in those cured), wherein CACNA1D mutations were most prevalent (63% versus 33% in those cured). In adjusted regression models, independent predictors of postoperative residual PA included Black versus White race (odds ratio, 5.10 [95% CI, 1.45–17.86]), AVS lateralization only at baseline (odds ratio, 8.93 [95% CI 3.00–26.32] versus both at baseline and after cosyntropin stimulation), and CT-AVS disagreement (odds ratio, 2.75 [95% CI, 1.20–6.31]). CONCLUSIONS: Multifocal, asymmetrical bilateral PA is relatively common, and it cannot be excluded by robust AVS lateralization. Long-term postoperative monitoring should be routinely pursued, to identify residual PA and afford timely initiation of targeted medical therapy.
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