Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism

被引：76

作者：

Nanba, Aya T.

Nanba, Kazutaka ^{[2
]}

Byrd, James B. ^{[3
]}

Shields, James J. ^{[4
]}

Giordano, Thomas J. ^{[5
]}

Miller, Barbara S. ^{[6
]}

Rainey, William E. ^{[1
,2
]}

Auchus, Richard J. ^{[1
,7
]}

Turcu, Adina F. ^{[1
]}

机构：

[1] Univ Michigan, Div Metab Endocrinol & Diabet, Ann Arbor, MI 48109 USA

[2] Univ Michigan, Dept Mol & Integrat Physiol, Ann Arbor, MI 48109 USA

[3] Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI 48109 USA

[4] Univ Michigan, Dept Radiol, Ann Arbor, MI 48109 USA

[5] Univ Michigan, Dept Pathol, Ann Arbor, MI 48109 USA

[6] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA

[7] Univ Michigan, Dept Pharmacol, Ann Arbor, MI 48109 USA

来源：

CLINICAL ENDOCRINOLOGY | 2017年 / 87卷 / 06期

关键词：

adrenal vein sampling; aldosterone producing adenoma; CYP11B2; primary aldosteronism;

D O I：

10.1111/cen.13442

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

ObjectiveCorrect subtyping of primary aldosteronism (PA) is essential for good surgical outcomes. Adrenal vein sampling (AVS) and/or computed tomography (CT) are used for PA subclassification. Clinical and/or biochemical improvement after surgery, however, is not always achieved in patients with presumed unilateral PA. We aimed to identify the pitfalls in PA subclassification leading to surgical treatment failures. Patients and DesignWe retrospectively studied 208 patients who underwent adrenal vein sampling (AVS) for PA subclassification in a tertiary referral centre, between January 2009 and August 2016. Simultaneous bilateral AVS was performed before and after cosyntropin administration. We implemented immunohistochemistry for aldosterone synthase (CYP11B2) and 17-hydroxylase/17,20 lyase (CYP17A1) in adrenal glands resected from patients without improvement of PA after surgical treatment and from those with limitations in AVS interpretation. ResultsOf 55 patients who underwent adrenalectomy, three (5.5%) had no improvement of PA. All three patients underwent partial adrenalectomy to remove a CT-detected nodule present on the same side with AVS lateralization. Immunohistochemistry revealed a CYP11B2-negative nodule in both cases available. All patients who underwent total adrenalectomy based on AVS lateralization benefitted from surgery, including three patients with unilateral unsuccessful AVS and aldosterone suppression in the catheterized side vs inferior vena cava. ConclusionsRadiographically identified adrenal nodules are not always a source of PA, even when ipsilateral with AVS lateralization. These data caution against reliance on imaging findings, either alone or in conjunction with AVS, to guide surgery for PA.

引用

页码：665 / 672

页数：8

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