Node-by-node diagnosis for multiple ipsilateral nodules by segmental adrenal venous sampling in primary aldosteronism.
Clin Endocrinol (Oxf)
; 98(4): 487-495, 2023 04.
Article
en En
| MEDLINE
| ID: mdl-36471563
ABSTRACT
OBJECTIVES:
In patients with primary aldosteronism (PA), multiple adrenocortical nodules may be present on the surgical side. The aim of this study was to clarify the pathological diagnosis and the node-by-node diagnostic capability of segmental adrenal venous sampling (sAVS).DESIGN:
Retrospective study. PATIENTS A total of 162 patients who underwent adrenalectomy following sAVS were studied. MEASUREMENTS Multiple nodules on the surgical side were extracted while referring to contrast-enhanced computed tomography images. We also performed a detailed histopathological analysis of the resected specimens from patients undergoing sAVS, which included immunohistochemistry for CYP11B2.RESULTS:
In 11 (6.8%) patients, two to three nodules were detected on the surgical side. All patients were diagnosed by sAVS with at least one aldosterone-producing adenoma (APA) for localized aldosterone elevation in tributaries. Seven patients showed a lateralization index value of ≥4 after ACTH stimulation. Histopathologically and clinically, two patients had two or three CYP11B2-positive APAs, and the other nine patients both APAs and non-APAs. The positive predictive value of the most suspected APA, that is, the drainer that showed the highest aldosterone level by sAVS, was 11/11 (100%, 95% confidence interval [CI] 71.5%-100%), while that for the second and third suspected APA was 3/7 (42.9%, 95% CI 9.9%-81.6%), and they were significantly different (p = .01). Further, the positive predictive value of non-APA was 4/4 (100%, 95% CI 39.8%-100%).CONCLUSIONS:
The sAVS could correctly diagnose the aldosterone production in multiple ipsilateral adrenal nodules.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Adenoma Corticosuprarrenal
/
Hiperaldosteronismo
Tipo de estudio:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Revista:
Clin Endocrinol (Oxf)
Año:
2023
Tipo del documento:
Article
País de afiliación:
Japón