Despite Limited Specificity, Computed Tomography Predicts Lateralization and Clinical Outcome in Primary Aldosteronism

作者：Kline G A^*; Dias V C; So B; Harvey A; Pasieka J L

来源：World Journal of Surgery, 2014, 38(11): 2855-2862.

DOI：10.1007/s00268-014-2694-9

Computed tomography (CT) of the adrenals is a common first step for investigation of primary aldosteronism (PA). However, prior studies report poor specificity, necessitating adrenal vein sampling (AVS) prior to surgical consideration. %26lt;br%26gt;We examined our AVS database to determine whether CT adrenal findings could help select patients with a high likelihood of lateralization by AVS or high-value blood pressure (BP) outcomes. Subjects (N = 113) with validated outcomes were divided into groups of CT %26apos;positive%26apos; or CT %26apos;negative%26apos; according to the presence or absence of an adrenal mass and compared for the outcomes of lateralization by AVS or proportions achieving normotension off medications following surgery. %26lt;br%26gt;For patients with CT adrenal masses, there was a significantly higher odds ratio (OR) for both outcomes (6.3 and 9.7, p %26lt; 0.01). In subgroup analysis, age %26lt; 40 years carried particularly high odds for lateralization and cure when a CT mass was present (ORs 45 and 26, p %26lt; 0.01). Young individuals with normal CT adrenals rarely lateralized (10 %) and, in such patients, even factors like hypokalemia, body mass index (BMI), and plasma aldosterone level did not change the result on regression analysis. %26lt;br%26gt;CT-imaged adrenal masses strongly predicted lateralization by AVS and normotension with surgical treatment of lateralized PA. In PA, CT-positive patients should indeed be offered AVS and/or surgery given the high chance of good outcomes; younger CT-negative patients should be advised of a low chance of finding surgical disease by AVS.

• 出版日期2014-11