Clinical Study Of Subtype Diagnosis Of Adrenal CT Structure And Adrenal Venous Sampling In Patients With Primary Aldosteronism

Objective: To investigate the correlation and consistency of the morphological structure of adrenal CT and the subtype diagnosis of adrenal venous sampling in patients with primary aldosteronism,and to provide a decision basis for accurate positioning of surgical operation and other treatment methods.Methods: A total of 69 patients diagnosed with primary aldosteronism in the hypertensive area of the First Affiliated Hospital of Guangxi Medical University from October 2016 to December 2017 were collected and divided into three groups(Adenoma group,hyperplasia group and normal structure group)according to the morphological structure of adrenal CT.Adrenal Venous Sampling(AVS)was used to measure the concentration of cortisol and aldosterone in adrenal veins,right atrium and Inferior vena cava.Age,sex,serum potassium,blood pressure,kidney function,cortisol,standing plasma aldosterone(PAC),and standing plasma renin activity(PRA),standing angiotensin(AT),ARR,PAC inhibition and inhibition ratio before and after saline inhibition test,aldosterone/cortisol ratio(A/C)of bilateral adrenal venous and other indicators were compared among the three groups.Results:1The level of serum potassium in patients with adenoma was lower than that in patients with normal structure and hyperplasia group(P < 0.05).The DBP in patients with hyperplasia was lower than that in patients with adenoma and normal structure patients(P < 0.05),and the 24 hDBP in patients with hyperplasia was lower than that in patients with adenoma(P < 0.05).There was no difference in the levels of the age,sex,SBP,24 hSBP,pulse pressure,renal function indexes,cortisol,standing PAC,PRA,AT,ARR,PAC inhibition and PAC inhibition ratio of the three groups(P > 0.05);2The distribution of CT lesions was no difference between the patients of the adenoma group and hyperplasia group in left,right,or bilateral adrenal glands(P > 0.05);3AVS results: There was no difference between the three groups of adrenal venous aldosterone/cortisol ratio(A/C)and the dominant secretions(P > 0.05).The proportion of unilateral adrenal predominant secretion was 70%(21/30)in the adenoma group,36.7%(11/30)in the hyperplasia group,and 33.3%(3/9)in the normal structure group.The predominant secretory ratio in patients with adenoma was significantly higher than that in the hyperplasia group and the normal structure group(P < 0.01),but there was no significant difference between the hyperplasia group and the normal structure group(P > 0.05);4The analysis of patients with predominant secretion showed that there were 21 cases in the adenoma group,in which 11 cases were secreted on the left side and 10 cases were on the right side.A total of 15 cases(71.4%)showed idiopathic and CT lesions on the same side,and 6 cases(28.6%)showed contralateral.A total of 11 patients in the hyperplasia group had predominant secretion.Among them,there were 8 cases of dominant left secretion and 3 cases of right side secretory secretion.A total of 8 cases(72.7%)were ipsilateral and 3 cases(27.3%)were contralateral.In the normal structure group,there were 3 cases with predominant secretion,including 1 case of dominant left secretion and 2 cases of right side secretory secretion.There was no significant difference between the three groups in the predominant secretion(P > 0.05).There was no statistically significant difference between the same and contralateral dominant side and CT lesions in the adenoma group and the hyperplasia group(P > 0.05).5Regression analysis found that when AVS results were divided into groups,through binary logistic regression analysis,the predominant secretion of AVS was positively correlated with CT structure(P < 0.05),but was no correlation between the age,sex,serum potassium,PAC,PRA,ARR,PAC inhibition before and after saline inhibition test(P > 0.05),and was not related to the location of the adenoma(P > 0.05).Conclusion:The level of serum potassium in patients with adenoma was lower than that in patients with normal structure and hyperplasia;AVS found that 70% of patients with adenoma,36.7% with proliferative and 33.3% with normal structure had unilateral dominant secretion;In patients with unilateral predominant secretion of adenomas and hyperplasias,28.6% of adenomas and 27.2% of hyperplasias shows that the unilateral dominant secretion is on the opposite side of CT lesions.Clinically,judging the surgical site based solely on the adenoma or hyperplasia of the CT image structure results in approximately 30% of patients receiving unnecessary surgery.