Diagnostic strategy of primary aldosteronism based on CT scan and serum potassium level
10.3760/cma.j.issn.1671-7368.2019.07.011
- VernacularTitle:肾上腺CT联合血钾检测定位诊断原发性醛固酮增多症的临床分析
- Author:
Yu ZHANG
1
;
Hai LI
;
Guohong WEI
;
Jianbin LIU
;
Wanping DENG
;
Xiaopei CAO
;
Yanbing LI
Author Information
1. 中山大学附属第一医院内分泌科
- Keywords:
Hyperaldosteronism,primary;
Adrenal gland neoplasms;
Hypokalemia;
Tomography,X-Ray computed
- From:
Chinese Journal of General Practitioners
2019;18(7):668-671
- CountryChina
- Language:Chinese
-
Abstract:
One hundred and forty-five patients with primary aldosteronism (PA) admitted from 2006 to 2013 were enrolled in the study. The diagnosis of PA was confirmed by upright furosemide test and all patients met the following criteria: ① round-or oval-shaped lesion of low density with diameter>1 cm in one adrenal gland shown in contrast CT scan; ② no lesion or abnormality in contralateral adrenal gland; ③serum potassium level<3.5 mmol/L. Of 145 patients, 106 underwent total adrenalectomy, 36 partial adrenalectomy and 3 tumor enucleation. Serum potassium was (2.75±0.55) mmol/L before and (4.03±0.46) after surgery. Potassium was normalized after treatment in 141 cases (97.2％) with correction or improvement in hypertension; 4 patients (2.8％) remained hypokalemic and received spironolactone. Patients with normalized potassium were followed up for a medium period of 74 months (22—103 months), of whom 32 (22.7％) dropped off; the remaining 109 (77.3％) patients did not have hypokalemia. Multivariate linear correlation analysis showed that serum potassium level was negatively correlated with tumor diameter (r=?0.273,95％ CI:?0.086—?0.564, P=0.026) and basal serum aldosterone level (r=?0.261,95％ CI:?0.047— ?0.514, P=0.036). In PA patients with unilateral adrenal macroadenoma and hypokalemia, satisfactory surgical resolution can be achieved without adrenal venous sampling in majority of patients.
