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1.
J Comput Assist Tomogr ; 44(1): 153-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939897

RESUMO

OBJECTIVE: The aim of this study was to assess the utility of 70-kilovoltage-peak (kVp) contrast-enhanced computed tomography (CECT) for visualization and identification of the right adrenal vein (RAV) in comparison with that of conventional 120-kVp CECT. METHODS: This retrospective study included patients who underwent adrenal venous sampling with concurrent biphasic 120-kVp (120-kVp group, n = 43) or 70-kVp (70-kVp group, n = 47) CECT. Signal-to-noise ratios, contrast-to-noise ratios, longitudinal lengths, conspicuity scores, RAV detection rates, and size-specific dose estimates were compared between the 2 groups. RESULTS: In comparison with the 120-kVp group, the 70-kVp group had significantly higher signal-to-noise and contrast-to-noise ratios (P < 0.001-P = 0.033), greater longitudinal lengths (P < 0.001-P = 0.002), superior conspicuity scores for the RAV (P < 0.001), higher RAV detection rates (P = 0.015-P = 0.033), and lower size-specific dose estimates (P < 0.001). CONCLUSIONS: Seventy-kilovoltage-peak CECT has advantages over conventional 120-kVp CECT and is potentially useful for noninvasive assessment of the precise anatomy of the RAV.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Angiografia por Tomografia Computadorizada/métodos , Hiperaldosteronismo/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Estudos Retrospectivos , Sensibilidade e Especificidade , Razão Sinal-Ruído
3.
J Med Life ; 12(3): 215-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31666819

RESUMO

The final stage of the diagnostic of primary hyperaldosteronism is to identify the causes of excessive secretion of aldosterone and determination of its variants. Based on the analysis of literature data, the diagnostic value, sensitivity and specificity of the methods of radiation diagnostics for primary hyperaldosteronism were assessed: ultrasound, computed tomography, magnetic resonance imaging, photon emission tomography, magnetic resonance spectroscopy, scintigraphy with iodine radiopharmaceuticals. The causes of false-positive and false-negative evaluations of changes in adrenal glands in the application of these diagnostics have been analyzed. There are many genetic and morphological studies when searching the literature data on the principles and methods of distinguishing the nosological forms of primary hyperaldosteronism based on the results of the aldosterone level estimation in the separated blood from the central veins of both adrenal glands or segmental veins of one gland with subsequent determination of the concentration gradient. It was noted that topical diagnostics and, especially, the determination of nosological forms of primary hyperaldosteronism are complex and expensive, but their results allow choosing an appropriate treatment approach for each particular case.


Assuntos
Técnicas de Laboratório Clínico , Hiperaldosteronismo/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Aldosterona/metabolismo , Humanos , Hiperaldosteronismo/diagnóstico por imagem , Hiperaldosteronismo/patologia , Tomografia Computadorizada por Raios X
4.
Hypertension ; 74(4): 784-792, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476909

RESUMO

Primary aldosteronism is a common form of endocrine hypertension mainly caused by a unilateral aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH). AT1R-Abs (autoantibodies to the angiotensin II type 1 receptor) have been reported in patients with disorders associated with hypertension. Our objective was to assess AT1R-Ab levels in patients with primary aldosteronism (APA, n=40 and BAH, n=40) relative to patients with primary hypertension (n=40), preeclampsia (n=23), and normotensive individuals (n=25). AT1R-Abs in whole sera were measured using 2 different ELISAs which gave contrasting results. A functional cell-based assay was used to quantify activation of the AT1R (angiotensin II type 1 receptor) using whole sera or affinity-purified antibodies in the absence or presence of losartan (a specific AT1R antagonist). Serum samples from all groups displayed different levels of AT1R activation with different responses to losartan. Patients with BAH displayed higher losartan-independent affinity-isolated agonistic AT1R-Ab levels compared with patients with APA (P<0.01) and with normotensive individuals (P<0.0001). In patients with APA, BAH, and primary hypertension combined, higher aldosterone-to-renin ratios and lower plasma renin concentrations were associated with higher compared with lower agonistic AT1R-Ab levels. In patients with primary aldosteronism, higher AT1R-Ab activity was associated with an increased likelihood of a diagnosis of BAH compared with APA and with the presence of adrenal hyperplasia detected by computed tomography. Taken together, these data suggest that agonistic AT1R-Abs may have a functional role in a subgroup of patients with primary aldosteronism.


Assuntos
Autoanticorpos/imunologia , Hiperaldosteronismo/imunologia , Receptor Tipo 1 de Angiotensina/imunologia , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Hiperaldosteronismo/diagnóstico por imagem , Hipertensão/imunologia , Masculino , Pessoa de Meia-Idade , Pré-Eclâmpsia/imunologia , Gravidez , Tomografia Computadorizada por Raios X
5.
Tohoku J Exp Med ; 248(1): 31-36, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31092738

RESUMO

Aldosterone affects various systems and organs, including the cardiovascular system, through mineralocorticoid receptors. We here report a primary aldosteronism patient with severe cardiac dysfunction who showed dramatic improvement after laparoscopic adrenalectomy. The 57-year-old man presented with acute heart failure exacerbation. Performance status was 4, and New York Heart Association classification was 4. Echocardiography showed diffuse hypokinetic wall motion with an ejection fraction of 20%. The patient was found to have a high plasma level of brain natriuretic peptide (4,935 pg/mL), hypokalemia (2.7 mEq/L), an extremely elevated plasma aldosterone concentration (1,804 pg/mL), and high aldosterone-to-renin ratio [plasma aldosterone concentration (pg/mL)/plasma renin activity (ng/mL/hr)] (9,002). Computed tomography revealed a tumor 42 mm in diameter in the right adrenal gland. Primary aldosteronism was diagnosed with adrenal venous sampling. Medical treatment for heart failure was continued for several months, but the cardiac function was not sufficiently improved, suggesting the indication of heart transplantation. However, the patient could not be considered a candidate because of the adrenal tumor. Laparoscopic adrenalectomy was therefore performed. Immediately after surgery, echocardiography showed improved wall motion with an ejection fraction of 36%. Performance status and New York Heart Association classification were improved to 0 and 2, respectively. The present case has shown the efficacy of laparoscopic adrenalectomy for primary aldosteronism patients with severe heart failure.


Assuntos
Adrenalectomia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Testes de Função Cardíaca , Hiperaldosteronismo/fisiopatologia , Hiperaldosteronismo/cirurgia , Laparoscopia , Biópsia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Hormônios/metabolismo , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Radiografia Torácica , Fatores de Tempo
7.
Nucl Med Commun ; 40(6): 568-575, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30694876

RESUMO

BACKGROUND: Primary aldosteronism (PA) is a common cause of secondary hypertension. Among the many leading causes of PA, the two most frequent are, bilateral adrenal hyperplasia (BAH) and aldosterone-producing adenomas (APA). Since a solitary APA may be cured surgically, but BAH needs lifelong pharmacologic therapy, confirmation is mandatory before surgery. We herein sought to determine the diagnostic value of iodine-131 6-beta-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy to distinguish BAH from APA. PATIENTS AND METHODS: Patients clinically suspected of PA from March 2000 to October 2016 were retrospectively analyzed. A total of 145 patients, including 74 postunilateral adrenalectomy and seven postradiofrequency ablation for adrenal mass, were reviewed. All patients received NP-59 adrenal scintigraphy prior to surgery. The accuracy of the NP-59 adrenal scintigraphy was confirmed by the pathologic findings and postoperative outcomes. RESULTS: Among 81 patients receiving interventional procedures for adrenal mass, adenoma was eventually diagnosed in 72 patients according to their pathologic results, with 60 unilaterally and seven bilaterally localized lesions by NP-59 scintigraphy; nevertheless, there were five negative findings initially. The sensitivity, specificity, and positive predictive value of NP-59 scintigraphy for APA detection were therefore 83.3, 44.4, and 92.3%, respectively. Moreover, single-photon emission computed tomography/computed tomography scan increased the sensitivity and specificity, but not the positive predictive value (85.0, 60.0, and 89.5%) of NP-59 scintigraphy in this study. CONCLUSION: NP-59 adrenal scintigraphy is a useful imaging test to detect APA. Lateralization by this modality prior to surgical intervention may reduce the need for such invasive procedures as adrenal venous sampling.


Assuntos
19-Iodocolesterol/análogos & derivados , Centros Médicos Acadêmicos , Glândulas Suprarrenais/diagnóstico por imagem , Hiperaldosteronismo/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Taiwan
8.
Hypertension ; 72(3): 641-649, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29987100

RESUMO

Unilateral primary aldosteronism is the most common surgically correctable form of endocrine hypertension and is usually differentiated from bilateral forms by adrenal venous sampling (AVS) or computed tomography (CT). Our objective was to compare clinical and biochemical postsurgical outcomes of patients with unilateral primary aldosteronism diagnosed by CT or AVS and identify predictors of surgical outcomes. Patient data were obtained from 18 internationally distributed centers and retrospectively analyzed for clinical and biochemical outcomes of adrenalectomy of patients with surgical management based on CT (n=235 patients, diagnosed from 1994-2016) or AVS (526 patients, diagnosed from 1994-2015) using the standardized PASO (Primary Aldosteronism Surgical Outcome) criteria. Biochemical outcomes were highly different according to surgical management approach with a smaller proportion in the CT group achieving complete biochemical success (188 of 235 [80%] patients versus 491 of 526 [93%], P<0.001) and a greater proportion with absent biochemical success (29 of 235 [12%] versus 10 of 526 [2%], P<0.001). A diagnosis by CT was associated with a decreased likelihood of complete biochemical success compared with AVS (odds ratio, 0.28; 0.16-0.50; P<0.001). Clinical outcomes were not significantly different, but the absence of a postsurgical elevated aldosterone-to-renin ratio was a strong marker of complete clinical success (odds ratio, 14.81; 1.76-124.53; P=0.013) in the CT but not in the AVS group. In conclusion, patients diagnosed by CT have a decreased likelihood of achieving complete biochemical success compared with a diagnosis by AVS.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Coleta de Amostras Sanguíneas/métodos , Hiperaldosteronismo/diagnóstico por imagem , Hiperaldosteronismo/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adrenalectomia/métodos , Adulto , Aldosterona/sangue , Biomarcadores/sangue , Feminino , Humanos , Hiperaldosteronismo/sangue , Masculino , Pessoa de Meia-Idade , /estatística & dados numéricos , Renina/sangue , Estudos Retrospectivos , Veias
9.
BMJ Case Rep ; 20182018 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-29884668

RESUMO

A 53-year-old African man with a 25-year history of uncontrolled hypertension and systolic heart failure presented with an acute congestive heart failure exacerbation. He was found to have severe hypokalaemia, so additional testing was performed, and primary aldosteronism was confirmed. CT scan showed a 1.2×2.4 cm well-defined, homogeneous adenoma of the left adrenal gland. Adrenal vein sampling confirmed unilateral primary aldosteronism with lateralisation to the left adrenal gland. The patient was started on spironolactone and was referred to surgery for laparoscopic left adrenalectomy. Primary aldosteronism is associated with high cardiovascular morbidity and mortality due to activation of cardiac mineralocorticoid receptors. Studies suggest these negative effects can be reduced with early intervention and treatment. This case highlights the importance of investigating secondary causes of hypertension in young patients and the potential adverse cardiac effects of primary aldosteronism when it goes undiagnosed and untreated for years.


Assuntos
Terapia Combinada/métodos , Insuficiência Cardíaca Sistólica/etiologia , Hiperaldosteronismo/diagnóstico por imagem , Hiperaldosteronismo/terapia , Adrenalectomia , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Humanos , Hiperaldosteronismo/complicações , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Espironolactona/uso terapêutico , Tomografia Computadorizada por Raios X
10.
BMJ Case Rep ; 20182018 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-29572370

RESUMO

In this paper, we present two women with hypokalaemic rhabdomyolysis in the context of increased diuretic intake and gastroenteritis, respectively. While their clinical manifestations and laboratory results were strikingly similar, two different underlying disorders were subsequently unveiled. The first patient was diagnosed with Conn syndrome, and adrenalectomy led to significant improvement of hypertension and sustained normokalaemia. The diagnosis in the second patient was Gitelman syndrome. Electrolyte supplements improved long-term lassitude and the frequency of muscle cramps declined significantly. These case vignettes illustrate the importance of establishing the underlying cause of hypokalaemia.


Assuntos
Síndrome de Gitelman/diagnóstico , Hiperaldosteronismo/diagnóstico , Adrenalectomia , Diagnóstico Diferencial , Suplementos Nutricionais , Feminino , Síndrome de Gitelman/complicações , Síndrome de Gitelman/diagnóstico por imagem , Síndrome de Gitelman/tratamento farmacológico , Humanos , Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico por imagem , Hiperaldosteronismo/cirurgia , Hipertensão/etiologia , Hipopotassemia/etiologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Potássio/administração & dosagem , Rabdomiólise/etiologia , Adulto Jovem
11.
Clin Endocrinol (Oxf) ; 88(5): 645-651, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29464741

RESUMO

CONTEXT: The current Endocrine Society Guideline suggests that patients aged <35 years with marked primary aldosteronism (PA) and unilateral adrenal lesions on adrenal computed tomography (CT) scan may not need adrenal vein sampling (AVS) before proceeding to unilateral adrenalectomy. This suggestion is, however, based on the data from only one report in the literature. OBJECTIVE: We sought to determine the accuracy of CT findings in young PA patients who had unilateral adrenal disease on CT with hypokalaemia and elevation of aldosterone. DESIGN AND PATIENTS: We retrospectively studied 358 PA patients (n = 30, aged <35 years; n = 39, aged 35-40 years; n = 289, aged ≥40 years) with hypokalaemia and elevation of aldosterone and unilateral disease on CT who had successful AVS. MAIN OUTCOME MEASURE: Accuracy of CT findings is determined by AVS findings and/or surgical outcomes in patients aged <35 years. RESULTS: Concordance of the diagnosis between CT and AVS was 90% (27/30) in patients aged <35 years, 79% (31/39) in patients aged 35-40 years and 69% (198/289) in those aged ≥40 years (trend for P < .01). Surgical benefit was confirmed in three patients aged <35 years and in three patients aged 35-40 years with the available surgical data who had discordance between CT and AVS findings. Collectively, the diagnostic accuracy of CT findings was 100% (30/30) if aged <35 years and 87% (34/39) if aged 35-40 years. CONCLUSION: Primary aldosteronism patients aged <35 years with hypokalaemia and elevation of aldosterone and unilateral disease on adrenal CT could be spared AVS.


Assuntos
Aldosterona/sangue , Hiperaldosteronismo/sangue , Hiperaldosteronismo/diagnóstico por imagem , Hipopotassemia/sangue , Hipopotassemia/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
12.
J Clin Endocrinol Metab ; 103(3): 900-908, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29092077

RESUMO

Context: The number of centers with established adrenal venous sampling (AVS) programs for the subtype diagnosis of primary aldosteronism (PA) is limited. Objective: Aim was to develop an algorithm for AVS based on subtype prediction by computed tomography (CT) and serum potassium. Design: A multi-institutional retrospective cohort study in Japan. Patients: A total of 1591 patients with PA were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. Main Outcome Measure: Prediction value of the combination of CT findings and potassium status for subtype diagnosis. Results: The percentages of unilateral hyperaldosteronism on AVS were higher in patients with unilateral disease on CT than those with bilateral normal results on CT (50.8% vs 14.6%, P < 0.01), and these percentages were higher in those with hypokalemia than those with normokalemia (58.4% vs 11.5%, P < 0.01). The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2% (reference); unilateral disease on CT with normokalemia, 23.8% and 4.8 [95% confidence interval (CI), 3.1 to 7.2]; bilateral normal on CT with hypokalemia, 38.1% and 9.4 (95% CI, 6.2 to 14.1), and unilateral disease on CT with hypokalemia, 70.6% and 36.4 (95% CI, 24.7 to 53.5). Conclusions: Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.


Assuntos
Hiperaldosteronismo/diagnóstico , Potássio/sangue , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Algoritmos , Biomarcadores/sangue , Coleta de Amostras Sanguíneas/métodos , Feminino , Humanos , Hiperaldosteronismo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
13.
Eur J Radiol ; 98: 150-157, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29279155

RESUMO

OBJECTIVES: To compare image quality and radiation dose of right adrenal vein (RAV) imaging computed tomography (CT) among conventional, low kV, and low kV with reduced contrast medium protocols. METHODS: One-hundred-and-twenty patients undergoing adrenal CT were randomly assigned to one of three protocols: contrast dose of 600mgI/kg at 120-kV tube voltage setting (600-120 group), 600mgI/kg at 80kV (600-80 group), and 360mgI/kg at 80kV (360-80 group). Iterative reconstruction was used for 80-kV groups. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the RAV and size-specific dose estimates (SSDE) were measured. Three radiologists evaluated 4-point visualisation scores of RAV by consensus reading. RESULTS: The RAV detectability was 95%, 97.2%, and 97.3% for 600-120, 600-80, and 360-80 groups, respectively (p=1.000). Visualisation scores were not significantly different among the groups (p=0.152). There were no significant differences in CNR or SNR between the 600-120 and 360-80 groups. SSDE of the 360-80 group was significantly lower than that of the 600-120 group (5.86mGy±1.44 vs. 7.27mGy±1.81, p<0.001). CONCLUSIONS: 80-kV scans with 360 mgI/kg contrast media showed comparable detectability of RAV to conventional scans, while reducing 19% of SSDE.


Assuntos
Glândulas Suprarrenais/irrigação sanguínea , Glândulas Suprarrenais/diagnóstico por imagem , Meios de Contraste , Hiperaldosteronismo/diagnóstico por imagem , Doses de Radiação , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Razão Sinal-Ruído , Veias/diagnóstico por imagem
14.
J Hypertens ; 36(2): 353-360, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28902663

RESUMO

BACKGROUND: Primary aldosteronism is associated with a higher incidence of left ventricular (LV) hypertrophy and diastolic dysfunction than essential hypertension. However, systolic function via endocardial measurements is similar between patients with primary aldosteronism and essential hypertension. Speckle-tracking echocardiography is a sensitive tool which can detect subclinical impairments in systolic function. The aim of this study was to investigate aldosterone-induced subclinical impairments in systolic function. METHODS: We prospectively enrolled patients with primary aldosteronism and essential hypertension and analyzed their clinical data, biochemical data, and echocardiographic parameters, including myocardial strain [global longitudinal strain (GLS)]. RESULTS: Thirty-six patients with primary aldosteronism and 31 patients with essential hypertension were enrolled for analysis. The patients with primary aldosteronism had significantly lower serum potassium levels, lower plasma renin activity, higher aldosterone-to-renin ratio (ARR), and higher 24-h urinary aldosterone levels than patients with essential hypertension. With regards to echocardiographic parameters, the patients with primary aldosteronism had a thicker ventricular wall and higher LV mass index than those with essential hypertension. Most importantly, we found significant degradation of GLS in the patients with primary aldosteronism compared with those with essential hypertension (-17.84 ±â€Š2.36 vs. -20.13 ±â€Š2.32, P < 0.001). In correlation analysis, GLS was significantly correlated with serum potassium level, LV mass index, log-transformed plasma renin activity, log-transformed ARR, and log-transformed 24-h urinary aldosterone levels (all P < 0.05). Multivariate linear regression analysis further identified log-transformed ARR (ß = 0.771, 95% confidence interval: 0.011-1.530, P = 0.047), and log-transformed 24-h urinary aldosterone level (ß = 1.765, 95% confidence interval: 0.01-3.529, P = 0.050) as independent factors correlated with GLS. CONCLUSION: Patients with primary aldosteronism have a lower magnitude of GLS than patients with essential hypertension, suggesting that aldosterone induces a subclinical decline in LV systolic function.


Assuntos
Aldosterona/sangue , Hipertensão Essencial/fisiopatologia , Hiperaldosteronismo/diagnóstico por imagem , Hiperaldosteronismo/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Idoso , Aldosterona/urina , Ecocardiografia/métodos , Hipertensão Essencial/sangue , Hipertensão Essencial/diagnóstico por imagem , Feminino , Coração/fisiopatologia , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hipertensão , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Miocárdio , Potássio/sangue , Estudos Prospectivos , Renina/sangue , Sístole , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia
15.
Eur J Radiol ; 96: 104-108, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29103467

RESUMO

PURPOSE: To evaluate the visualization of the right adrenal vein (RAV) on dynamic contrast-enhanced computed tomography (CT) images in patients with primary aldosteronism. MATERIALS AND METHODS: We evaluated 27 consecutive patients with primary aldosteronism who underwent contrast-enhanced dynamic CT and subsequent adrenal venous sampling. Scan delays were 10-, 20- and 60-s after a bolus-tracking program detected that the threshold of a 100 Hounsfield units (HU) increase in the abdominal aorta had been achieved. RAV visualization for each phase was evaluated by two readers using a four-point scale. The Friedman and McNemar tests were employed to compare the confidence ratings and the RAV visualization rates between the three phase images. RESULTS: The RAV visualization rates were 20.4%, 83.3%, and 63.0%, for the first, second, and third phase, respectively. The RAV visualization rates were 92.6%, 83.3%, 63.0%, and 92.6% for all three phases combined, the first and second phase image combined, the first and third phase image combined, and second and third phase image combined. The combined second and third phase images had the highest RAV visualization rates compared with all other image combinations (P<0.0001). CONCLUSION: RAV visualization was significantly improved by combining the second and third phase images.


Assuntos
Glândulas Suprarrenais/diagnóstico por imagem , Hiperaldosteronismo/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Veia Cava Inferior/diagnóstico por imagem , Glândulas Suprarrenais/irrigação sanguínea , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Hiperaldosteronismo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Intensificação de Imagem Radiográfica , Estudos Retrospectivos
18.
Eur J Endocrinol ; 177(5): 431-437, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28794160

RESUMO

OBJECTIVE: Patients with primary aldosteronism (PA) have a high prevalence of osteoporosis (OP) and fractures (Fx). We evaluated the presence of PA in patients admitted to our metabolic bone disease outpatient clinic. DESIGN: Study conducted on an in- and outpatient basis in a referral Italian endocrinology unit. METHODS: A total of 2632 patients were evaluated. 2310 were excluded because they were taking drugs known to affect bone or mineralocorticoids metabolism or were diagnosed to have a secondary cause of osteoporosis. The remaining 322 subjects (304 females, 18 males) took part in the study. Bone mineral density (BMD) and thoracic and lumbar spine vertebral morphometry were performed by dual X-ray absorptiometry. All patients were screened for PA with aldosterone-to-renin ratio. In those who had positive results, confirmatory tests were performed. RESULTS: Among 322 subjects, 213 were osteoporotics and 109 were not. PA was diagnosed in eleven out of 213 osteoporotic patients (5.2%) and one out of 109 non-osteoporotic subjects (0.9%, P = 0.066). PA was observed in the 26.1% of patients with the concomitant presence of osteoporosis, hypertension and hypercalciuria. Compared with patients without PA, patients with PA had mean values of urinary calcium excretion, 4.8 ± 2.5 mmol/day vs 7.6 ± 3.2 mmol/day, P < 0.001 and serum PTH levels, 5.4 pmol/L vs 7.3 pmol/L, P < 0.01, significantly higher. CONCLUSIONS: PA should be considered among the causes of secondary OP.


Assuntos
Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Osteoporose/etiologia , Absorciometria de Fóton/métodos , Idoso , Estudos Transversais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/tendências
19.
J Hypertens ; 35(12): 2486-2492, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28708774

RESUMO

OBJECTIVE: The current study aimed to evaluate the role of Küpers' score in predicting unilateral aldosteronism, and develop a modified score in Chinese patients with primary aldosteronism. METHODS: The current retrospective study included 406 patients with primary aldosteronism who underwent successful adrenal venous sampling (AVS) and were divided into the unilateral (n = 211) and bilateral (n = 195) groups according to the AVS results. Normokalemia was noted in both the unilateral (n = 64) and bilateral groups (n = 84) when plasma and urinary aldosterone were measured. RESULTS: We evaluated Küpers' prediction score, which had the best cutoff value at four points [area under the curve, 0.601 (95% confidence interval 0.551-0.650); specificity, 53%; sensitivity, 62%]. Then, we modified this score by using urinary aldosterone level quartiles, history of hypokalemia, and typical adenoma more than 10 mm on computed tomography (CT) [area under the curve, 0.745 (95% confidence interval 0.667-0.813)]; sensitivity, 45.3%; specificity, 90.5%). The best cutoff value to discriminate unilateral from bilateral disease was a score of 5. This modified prediction score only applied to patients who were normokalemic when urinary aldosterone was measured. A specificity of 100% was achieved at a score of 6 for patients aged 40 years or less, and 5 when the adrenal lesion was on the right side on CT imaging. CONCLUSION: Küpers' prediction score is not suitable for our patients. Urinary aldosterone levels combined with a history of hypokalemia are useful to discriminate unilateral from bilateral aldosteronism in patients with typical adenoma on the right adrenal gland on CT or in patients 40 years old or less.


Assuntos
Adenoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/irrigação sanguínea , Aldosterona/sangue , Hiperaldosteronismo/diagnóstico , Adenoma/sangue , Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Feminino , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
20.
Eur J Clin Invest ; 47(5): 372-377, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28299775

RESUMO

INTRODUCTION: The correct differentiation between unilateral and bilateral adrenal involvement in patients with primary aldosteronism (PA) is of utmost importance to justify surgical treatment. The aim of this study was to determine the accuracy of adrenal imaging compared to adrenal venous sampling (AVS), histopathology and postoperative outcome. METHODS: The data of all patients with unequivocal AVS who underwent unilateral laparoscopic adrenalectomy for primary aldosteronism between May 2004 and April 2015 were entered in this retrospective study. We compared computed tomography (CT) and magnetic resonance imaging (MRI) results with corresponding AVS data, histopathology findings and postoperative outcome. RESULTS: A total of 175 patients underwent unilateral laparoscopic adrenalectomy for primary aldosteronism. AVS was successful in 152 patients and postoperative outcome available in 148 patients. Despite unilateral disease according to AVS results, bilateral normal glands were seen in 15 MRI (17·2%) and 7 CT scans (8·5%), respectively. Unilateral enlargement of the nonhypersecreting adrenal gland was found in three MRI (3·5%) and 10 CT scans (12·2%) of patients who showed aldosterone hypersecretion deriving from the contralateral gland. Fifteen MRI (17·2%) and 18 CT scans (22·0%) revealed bilateral adrenal pathology despite unilateral aldosterone hypersecretion. CONCLUSION: The accuracy of CT and magnetic resonance imaging in predicting unilateral disease is poor. AVS appears to be an essential diagnostic step to identify those patients who may benefit from unilateral adrenalectomy.


Assuntos
Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Adenoma Adrenocortical/diagnóstico por imagem , Hiperaldosteronismo/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/cirurgia , Doenças das Glândulas Suprarrenais/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Doenças das Glândulas Suprarrenais/patologia , Doenças das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Adenoma Adrenocortical/diagnóstico , Adenoma Adrenocortical/cirurgia , Adulto , Idoso , Aldosterona/análise , Coleta de Amostras Sanguíneas , Feminino , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/cirurgia , Hiperplasia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Veias , Adulto Jovem
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