Retrospective Study On The Diagnostic Efficacy Of Adrenal Venous Blood Sampling For Primary Aldosteronism

Background and objective:Primary aldosteronism(PA)is the most common endocrine disease in secondary hypertension.With the continuous improvement of diagnosis and treatment technology,the incidence of PA is gradually increasing.The incidence of cardiovascular and cerebrovascular diseases,renal function injury and metabolic syndrome of PA was significantly higher than that of essential hypertension patients with matched disease course.The classification of PA greatly affects the choice of treatment plan and the prognosis of patients in clinical practice,so it is very important to make the correct classification of PA patients.At present,there are many methods of classification diagnosis,among which adrenal venous sampling(AVS)plays a very important role.AVS is an interventional method to determine physiological and pathological changes by detecting aldosterone and other indicators in samples,and is considered as the"gold standard"for PA classification diagnosis.But AVS is an invasive operation that is technically demanding and expensive.Its operation process and interpretation of results are controversial.To verify the value of AVS in the classification and diagnosis of PA,in order to provide reference for the standardized development of this technique in China and the clinical diagnosis and treatment of primary aldosteronism.Methods:Patients diagnosed with primary aldosteronism in the First Affiliated Hospital of Dalian Medical University from October 2017 to October 2022 were retrospectively analyzed.AVS results were used as the diagnostic criteria for PA classification,and clinical data of patients with different subtypes of PA were compared.The patients with different potassium levels were grouped to compare the difference of clinical data.The consistency rate of adrenal CT and AVS with pathological results was analyzed to verify the value of AVS in PA classification diagnosis.Results:(1)A total of 118 patients with PA were included,with an average age of49.95±11.35 years,an average BMI 26.82±3.92kg/m~2,and an average course of hypertension of 8(2,10)years,including 60 males(51%).Fifty-eight cases(49%)were female.3 patients(2.5%)had grade 1 hypertension;8 patients(6.8%)had grade 2hypertension;107 patients(90.7%)had grade 3 hypertension.52.5%(62 cases)had a first-degree relative with hypertension.13.6%(16 cases)were complicated with diabetes.There were 77 cases(71.30%)of unilateral aldosterone secretion and 31 cases(28.70%)of bilateral aldosterone secretion.50.85%(60 cases)of PA patients were associated with hypokalemia,and 49.15%(58 cases)of PA patients had normal blood potassium.(2)More smokers in Unilateral PA group,more urine potassium and sodium quantitation,larger left ventricular end-diastolic ID D,higher MA/Cre level,lower potassium level,and faster average pulse rate(P<0.05).(3)The proportion of males,serum creatinine level,MA/Cre level,serum sodium level and orthostatic aldosterone level in hypokalemia group were higher,and average pulse rate was lower(P<0.05).(4)There is no significant difference in the incidence of target organ damage between the two groups,whether it is grouped according to the AVS result(Unilateral PA group and IHA)or potassium level(normal and hypokalemia groups)(P>0.05).(5)The overall coincidence rate between CT and AVS was 58.3%.(6)Based on the pathological results,the accuracy of AVS in the diagnosis of unilateral adrenal lesions was higher than that of adrenal CT(100.00%vs78.18%),and the diagnosis of unilateral adrenal adenoma was similar to that of adrenal CT(83.78 vs 83.78%;The specificity was 27.27%vs 36.36%),and the sensitivity and specificity were 72.98%and 54.55%respectively.Conclusions:(1)In this study,50.85%of patients had hypokalemia,and the serum creatinine and MA/Cre levels were higher in the hypokalemia group,suggesting that hypokalemia is not a necessary condition for screening for primary aldosteronism,and patients with hypokalemia may have a higher and more severe incidence of renal injury.(2)The accuracy of AVS in the diagnosis of the dominant side of PA is better than that of adrenal CT.The combination of AVS and CT can improve the specificity of the diagnosis of unilateral adrenal adenoma.