Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein

被引：48

作者：

Pasternak, Jesse D. ^{[1
]}

Epelboym, Irene ^{[2
]}

Seiser, Natalie ^{[1
]}

Wingo, Matt ^{[2
]}

Herman, Max ^{[2
]}

Cowan, Vanessa ^{[2
]}

Gosnell, Jessica E. ^{[1
]}

Shen, Wen T. ^{[1
]}

Kerlan, Robert K., Jr. ^{[3
]}

Lee, James A. ^{[2
]}

Duh, Quan-Yang ^{[1
]}

Suh, Insoo ^{[1
]}

机构：

[1] Univ Calif San Francisco, Dept Surg, Sect Endocrine Surg, San Francisco, CA 94115 USA

[2] Columbia Univ, Endocrine Surg Sect, Dept Surg, New York, NY USA

[3] Univ Calif San Francisco, Dept Radiol & Biomed Imaging, San Francisco, CA 94115 USA

来源：

SURGERY | 2016年 / 159卷 / 01期

关键词：

SUPPRESSION;

D O I：

10.1016/j.surg.2015.06.048

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background. Adrenal venous sampling is an important lateralization study for primary aldosteronism, but inability to cannulate the right adrenal vein is not uncommon and interpreted as a failed study. We challenged this notion by examining whether data from incomplete left-sided adrenal venous sampling could accurately predict lateralization. Methods. Sixty-two adrenal venous sampling studies from 2007 to 2014 at 2 tertiary-care institutions were reviewed. For this analysis, data from the right adrenal vein were excluded. The study variable was the aldosterone:cortisol ratio of the left adrenal vein compared with the inferior vena cava (LAV/IVC). Scatterplot analysis identified high and low LAV/IVC cutoffs that predicted accurately unilateral disease in 1 institutional cohort and validated in the second cohort. Results. Thirty-six studies of adrenal venous sampling were evaluated at the first institution and divided into 3 diagnostic categories: unilateral-left (n = 14), unilateral-right (n = 12), and bilateral (n = 10). Cutoff values of the ratios of LAV/IVC of >= 5.5 and <= 0.5 accurately predicted left- and right-sided disease, respectively, and were validated in 26 studies from the second institution (100% PPV). The "5.5-0.5 criteria" salvaged accuracy for predicting lateralization in 50% of cases. Conclusion. Even in the setting of failed cannulation of the right adrenal vein, the actual data from-the remaining adrenal venous sampling can predict lateralization accurately in many patients. A "failed" adrenal venous sampling study may be of greater predictive utility than believed traditionally.

引用

页码：267 / 273

页数：7