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中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 186 -191. doi: 10.3877/cma.j.issn.1674-3253.2023.02.019

综述

无创诊断方法在原发性醛固酮增多症分型诊断中的应用及研究进展
季瑞冬1, 卢振权1,(), 罗兵锋1, 侯健1, 董汝男1, 廖苏才1, 罗光彦1, 梁伟2, 张可可2, 郭敏姗2, 卢捷娜3, 吴旻3, 杨伟洪4   
  1. 1. 518053 深圳,香港大学深圳医院外科部
    2. 518053 深圳,香港大学深圳医院内分泌科
    3. 518053 深圳,香港大学深圳医院心内科
    4. 518053 深圳,香港大学深圳医院介入科
  • 收稿日期:2022-11-10 出版日期:2023-04-01
  • 通信作者: 卢振权

Application and research progress of noninvasive diagnosis in the subtype classification of primary aldosteronism

Ruidong Ji1, Zhenquan Lu1(), Bingfeng Luo1   

  • Received:2022-11-10 Published:2023-04-01
  • Corresponding author: Zhenquan Lu
引用本文:

季瑞冬, 卢振权, 罗兵锋, 侯健, 董汝男, 廖苏才, 罗光彦, 梁伟, 张可可, 郭敏姗, 卢捷娜, 吴旻, 杨伟洪. 无创诊断方法在原发性醛固酮增多症分型诊断中的应用及研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(02): 186-191.

Ruidong Ji, Zhenquan Lu, Bingfeng Luo. Application and research progress of noninvasive diagnosis in the subtype classification of primary aldosteronism[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 186-191.

原发性醛固酮增多症(primary aldosteronism,PA)是继发性高血压的常见病因之一,全球患病率为5%~12%[1]。分型诊断是PA诊断中的关键点及难点。按照病因的不同,PA分为6型,主要包括醛固酮瘤(aldosterone-producing adenoma,APA)、原发性肾上腺皮质增生(又称单侧肾上腺增生) (primary or unilateral hyperplasia,PAH/UNAH)、特发性醛固酮增多症(idiopathic hyperaldosteronism,IHA)、分泌醛固酮的肾上腺皮质癌、异位醛固酮分泌瘤以及家族性醛固酮增多症(familial hyperplasia,FH)。不同分型以及优势分泌侧决定了不同的治疗方案,通常IHA、FH以药物治疗为主,APA及UNAH则首选手术治疗。指南推荐肾上腺静脉采血(adrenal venous sampling,AVS)为分型诊断的首选检查[2]。但AVS为有创操作,并且成本昂贵,技术要求高,这限制了其在临床上的广泛应用[3]。因此,大多数基层医院仍使用无创方法对PA进行分型诊断。本文就现有的无创分型诊断方法在临床的应用及进展进行综述,供临床工作者参考。

[1]
Dick SM, Queiroz M, Bernardi BL, et al. Update in diagnosis and management of primary aldosteronism.[J]. Clin Chem Lab Med, 2018, 56(3): 360-372.
[2]
原发性醛固酮增多症诊断治疗的专家共识(2020版)[J]. 中华内分泌代谢杂志, 2020,36(09): 727-736.
[3]
Naruse M, Umakoshi H, Tsuiki M, et al. The latest developments of functional molecular imaging in the diagnosis of primary aldosteronism.[J]. Horm Metab Res, 2017, 49(12): 929-935.
[4]
杨淑珺, 黄盼, 秦皓, 等. 肾上腺CT与肾上腺静脉采血在原发性醛固酮增多症分型诊断中的应用[J]. 现代泌尿外科杂志, 2020, 25(10): 880-884.
[5]
Lee FT, Elaraj D. Evaluation and management of primary hyperaldosteronism[J]. Surg Clin of North Am, 2019, 99(4): 731-745.
[6]
钟睿, 陈启光, 等. 利用CT表现鉴别肾上腺隐匿型嗜铬细胞瘤和皮质腺瘤[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(01): 12-16.
[7]
Campbell RA, Young DS, Shaver CN, et al. Influence of adrenal venous sampling on management in patients with primary aldosteronism independent of lateralization on cross-sectional imaging[J]. J Am Coll Surg, 2019, 229(1): 116-124.
[8]
Zhou Y, Wang D, Jiang L, et al. Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis[J]. BMJ Open, 2020, 10(12): e38489.
[9]
胡卫列, 吴义高. 再谈肾上腺静脉采血在原发性醛固酮增多症中的应用[J/OL].中华腔镜泌尿外科杂志(电子版), 2017, 11(01): 1-3.
[10]
Kocjan T, Janez A, Stankovic M, et al. A new clinical prediction criterion accurately determines a subset of patients with bilateral primary aldosteronism before adrenal venous sampling[J]. Endocr Pract, 2016, 22(5): 587-594.
[11]
Umakoshi H, Ogasawara T, Takeda Y, et al. Accuracy of adrenal computed tomography in predicting the unilateral subtype in young patients with hypokalaemia and elevation of aldosterone in primary aldosteronism[J]. Clin Endocrinol (Oxf), 2018, 88(5): 645-651.
[12]
Nanba AT, Nanba K, Byrd J B, et al. Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism[J]. Clin Endocrinol (Oxf), 2017, 87(6): 665-672.
[13]
Young WF, Stanson AW, Thompson GB, et al. Role for adrenal venous sampling in primary aldosteronism[J]. Surgery, 2004, 136(6): 1227-1235.
[14]
Kamemura K, Wada N, Ichijo T, et al. Significance of adrenal computed tomography in predicting laterality and indicating adrenal vein sampling in primary aldosteronism[J]. J Hum Hypertens, 2017, 31(3): 195-199.
[15]
Kempers MJ, Lenders JW, van Outheusden L, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism[J]. Ann Intern Med, 2009, 151(5): 329-337.
[16]
Li S, Ren Y, Zhu Y, et al. The potential clinical application of a lower bilateral adrenal limb width ratio (L/RW) in patients with bilateral parmary hyperaldosteronism[J]. Endocr Pract, 2019, 25(8): 830-835.
[17]
Li S, Sun H, Ma L, et al. Left-versus-right-adrenal-volume ratio as a screening index before adrenal venous sampling to identify unilateral primary aldosteronism patients[J]. J Hypertens, 2020, 38(2): 347-353.
[18]
Lu CC, Yen RF, Peng KY, et al. NP-59 Adrenal Scintigraphy as an Imaging Biomarker to Predict KCNJ5 Mutation in Primary Aldosteronism Patients[J]. Front Endocrinol (Lausanne), 2021, 12: 644927.
[19]
Gross MD, Shapiro B, Francis IR, et al. Scintigraphic evaluation of clinically silent adrenal masses[J]. J Nucl Med, 1994, 35(7): 1145-1152.
[20]
Lombardi CP, Raffaelli M, De Crea C, et al. Noninvasive adrenal imaging in hyperaldosteronism: is it accurate for correctly identifying patients who should be selected for surgery?[J]. Langenbecks Arch Surg, 2007, 392(5): 623-628.
[21]
Nomura K, Kusakabe K, Maki M, et al. Iodomethylnorcholesterol uptake in an aldosteronoma shown by dexamethasone-suppression scintigraphy: relationship to adenoma size and functional activity.[J]. The Journal of clinical endocrinology and metabolism, 1990, 71(4).
[22]
Soinio M, Luukkonen AK, Seppanen M, et al. Functional imaging with 11C-metomidate PET for subtype diagnosis in primary aldosteronism[J]. Eur J Endocrinol, 2020, 183(6): 539-550.
[23]
Burton TJ, Mackenzie IS, Balan K, et al. Evaluation of the sensitivity and specificity of (11)C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn's adenomas.[J]. The Journal of clinical endocrinology and metabolism, 2012, 97(1).
[24]
O'shea PM, O'donoghue D, Bashari W, et al. 11 C-Metomidate PET/CT is a useful adjunct for lateralization of primary aldosteronism in routine clinical practice.[J]. Clin Endocrinol(oxf), 2019, 90(5): 670-679.
[25]
Abe T, Naruse M, Young WJ, et al. A novel cyp11b2-specific imaging agent for detection of unilateral subtypes of primary aldosteronism[J]. J Clin Endocrinol Metab, 2016, 101(3): 1008-1015.
[26]
Bluemel C, Hahner S, Heinze B, et al. Investigating the Chemokine Receptor 4 as Potential Theranostic Target in Adrenocortical Cancer Patients[J]. Clin Nucl Med, 2017, 42(1): e29-e34.
[27]
Albano D, Agnello F, Midiri F, et al. Imaging features of adrenal masses[J]. Insights Imaging, 2019, 10(1): 1.
[28]
Zekan D, King RS, Hajiran A, et al. Diagnostic dilemmas: a multi-institutional retrospective analysis of adrenal incidentaloma pathology based on radiographic size[J]. BMC Urol, 2022, 22(1): 73.
[29]
王东, 姜歧涛.肾上腺瘤超声及MRI诊断的影像特征及病理特点分析[J].现代医用影像学, 2020, 29(01): 171-172.
[30]
Fuss TC, Brohm K, Fassnacht M, et al. Reassessment of postural stimulation testing as a simple tool to identify a subgroup of patients with unilateral primary aldosteronism[J]. J Clin Endocrinol Metab, 2022, 107(2): e865-e873.
[31]
Young WJ, Klee GG. Primary aldosteronism. Diagnostic evaluation[J]. Endocrinol Metab Clin North Am, 1988, 17(2): 367-395.
[32]
Plamondon I, Agharazii M, Douville P, et al. Morning plasma aldosterone predicts the subtype of primary aldosteronism independent of sodium intake[J]. Clin Exp Hypertens, 2007, 29(2): 127-134.
[33]
Kempers MJ, Lenders JW, van Outheusden L, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism[J]. Ann Intern Med, 2009, 151(5): 329-337.
[34]
Lau JH, Sze WC, Reznek RH, et al. A prospective evaluation of postural stimulation testing, computed tomography and adrenal vein sampling in the differential diagnosis of primary aldosteronism[J]. Clin Endocrinol (Oxf), 2012,76(2): 182-188.
[35]
罗盼雨, 陈士涵, 余叶蓉. 体位试验联合肾上腺CT诊断原发性醛固酮增多症中醛固酮瘤的价值初探[J]. 四川大学学报(医学版), 2020, 51(01): 87-91.
[36]
Jiang Y, Zhang C, Wang W, et al. Diagnostic value of ACTH stimulation test in determining the subtypes of primary aldosteronism[J]. J Clin Endocrinol Metab, 2015, 100(5): 1837-1844.
[37]
Sonoyama T, Sone M, Miyashita K, et al. Significance of adrenocorticotropin stimulation test in the diagnosis of an aldosterone-producing adenoma[J]. J Clin Endocrinol Metab, 2011, 96(9): 2771-2778.
[38]
Kita T, Furukoji E, Sakae T, et al. Efficient screening of patients with aldosterone-producing adenoma using the ACTH stimulation test[J]. Hypertens Res, 2019, 42(6): 801-806.
[39]
Moriy A, Yamamoto M, Kobayashi S, et al. ACTH stimulation test and computed tomography are useful for differentiating the subtype of primary aldosteronism[J]. Endocr J, 2017, 64(1): 65-73.
[40]
Kupers EM, Amar L, Raynaud A, et al. A clinical prediction score to diagnose unilateral primary aldosteronism[J]. J Clin Endocrinol Metab, 2012, 97(10): 3530-3537.
[41]
Kocjan T, Vidmar G, Popović P, et al. Validation of three novel clinical prediction tools for primary aldosteronism subtyping[J]. Endocr Connect, 2022,11(5):e210532.
[42]
Kobayashi H, Abe M, Soma M, et al. Development and validation of subtype prediction scores for the workup of primary aldosteronism[J]. J Hypertens, 2018, 36(11): 2269-2276.
[43]
Zhang Y, Niu W, Zheng F, et al. Identifying unilateral disease in Chinese patients with primary aldosteronism by using a modified prediction score[J]. J Hypertens, 2017, 35(12): 2486-2492.
[44]
Xiao L, Jiang Y, Zhang C, et al. A novel clinical nomogram to predict bilateral hyperaldosteronism in Chinese patients with primary aldosteronism[J]. Clin Endocrinol (Oxf), 2019, 90(6): 781-788.
[45]
Wang A, Wang Y, Liu H, et al. Bone and mineral metabolism in patients with primary aldosteronism: A systematic review and meta-analysis[J]. Front Endocrinol (Lausanne), 2022,13: 1027841.
[46]
Rossi GP, Ragazzo F, Seccia TM, et al. Hyperparathyroidism can be useful in the identification of primary aldosteronism due to aldosterone-producing adenoma[J]. Hypertension, 2012, 60(2): 431-436.
[47]
李亚楠, 张赛春, 臧丽, 等. 甲状旁腺激素水平在原发性醛固酮增多症及肾上腺无功能瘤患者鉴别诊断中的应用价值[J]. 解放军医学院学报, 2021, 42(09): 913-917.
[48]
Kometani M, Yoneda T, Aodo D, et al. Primary Aldosteronism with Parathyroid Hormone Elevation: A Single-center Retrospective Study[J]. Intern Med, 2021, 60(7): 993-998.
[49]
Nakamura Y, Satoh F, Morimoto R, et al. 18-oxocortisol measurement in adrenal vein sampling as a biomarker for subclassifying primary aldosteronism[J]. J Clin Endocrinol Metab, 2011,96(8): E1272-E1278.
[50]
Mulatero P, di Cella SM, Monticone S, et al. 18-hydroxycorticosterone, 18-hydroxycortisol, and 18-oxocortisol in the diagnosis of primary aldosteronism and its subtypes[J]. J Clin Endocrinol Metab, 2012,97(3): 881-889.
[51]
Eisenhofer G, Dekkers T, Peitzsch M, et al. Mass Spectrometry-Based Adrenal and Peripheral Venous Steroid Profiling for Subtyping Primary Aldosteronism[J]. Clin Chem, 2016, 62(3): 514-524.
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