| ObjectiveMultislice computed tomography is used to reconstruct the adrenal morphology in three dimensions,and the semi-automated volumetry is used to measure the adrenal gland volume in patients with hypertension,essential hypertension and normal adults.First of all,in order to establish the normal reference range of adrenal gland volume and to explore the relevant influencing factors of adrenal gland volume,and secondly,to further explore the diagnostic value of adrenal gland volume in adrenal hypertension and to provide new ideas for the diagnosis and treatment of adrenal hypertension in clinic.methodsCollected from January 2017 to September 2020 in the First Affiliated Hospital of Zhengzhou University endocrinology department of 327 patients with adrenal hypertension and 80 patients with essential hypertension.Adrenal hypertension including primary aldosteronism,adrenal cortisol producing adenoma.Patients with essential hypertension are regarded as the EH group,and patients with adrenal hypertension are regarded as the AH group.At the same time,1031 healthy adults who underwent physical examination at the Physical Examination Center of the First Affiliated Hospital of Zhengzhou University during the same period were selected as the normal control group(NC group).Collected the gender,age,height,weight,blood pressure,fasting blood glucose,HbAlc,blood lipids and adrenal gland(or abdomen)MSCT images of all research subjects,and calculate body mass index(BMI)and body surface area(BSA),and use semi-automated volumetry to measure adrenal gland volume.At the same time,collected the adrenal-related hormone data of 80 subjects in the NC group,EH group and AH group.In addition,89 patients diagnosed with PA in the Department of endocrinology of the First Affiliated Hospital of Zhengzhou University from October 2020 to April 2021 were collected.Results1 The total volume of the bilateral adrenal glands of the 1031 subjects in the NC group was 6.53(5.50,7.86)cm3,of which the LAV was 3.57(3.03,4.33)cm3 and the RAV was 2.97(2.42,3.53)cm3.The left adrenal gland volume was larger than the right Side,the difference was statistically significant(P<0.001).2 The AGV of males in the NC group was higher than that of females(P<0.001).After applying the general linear model to adjust weight,height,and BSA,the LAV,RAV,and TAV were still different among different genders(F=3.368,4.600,4.493,both P<0.05).3 The NC group was divided into five age groups:18-28 years old,29-40 years old,41-50 years old,51-60 years old and>60 years old.The volume of the adrenal glands increases first and then decreases with age:In the young group,the adrenal gland volume of the 29-40 year old group was larger than that of the 18-28 year old group(P<0.01),the middle-aged group tended to be stable(P>0.05),and the adrenal gland volume of the elderly group began to decrease(P<0.01).4 AGV is positively correlated with height,weight,BMI,BSA,blood pressure,FBG,and triglycerides,and negatively correlated with age,CT value,and HDL(P<0.01).However,its correlation with height,BMI,BSA,blood pressure,FBG,triglycerides,HDL,and CT values disappeared after adjusting for weight factors(all P>0.05).5 AGV was positively correlated with testosterone and 24h UFC(both P<0.01).After applying the partial correlation analysis to adjust BMI,the correlation disappeared(P>0.05).6 There are significant differences in AGV between the AH group,EH group and NC group.The AGV of the AH group is the largest,and the AGV of the NC group is the smallest(P<0.05).Among the three groups,LAV increased compared with RAV,and the difference was statistically significant(P<0.001).7 The AGV of PA group,CPA group and PCC group were increased compared with EH group and NC group(P<0.001).There was different in TAV among the three groups(P<0.001).Among them,the PCC group had the largest TAV and the PA group had the smallest TAV.Increased bilateral adrenal gland volume has good predictive value for PA,CPA and PCC(AUC=0.933,0.976,and 0.986,all P<0.001),and the cut-off point for predicting PA disease is 9.045 cm3(sensitivity and specificity are 80.7%,90.2%);the cut-off value for predicting CPA is 11.23 cm3(sensitivity and specificity are 89.8%,99.4%);the cut-off point for predicting PCC is 10.99 cm3(sensitivity and specificity are 97.5%,98.9%).8 Compared between the APA and IHA groups,the ratio of 24-hour urine aldosterone,ARR,LAV,TAV,and left/right adrenal gland volume in the APA group was higher than that in the IHA group,and the serum potassium value was lower than IHA group.The difference was statistically significant(P<0.05).The volume of adrenal glands on the affected side and the contralateral side of the APA group was increased compared with that of the EH group and the NC group on the same side(P<0.001).The left/right volume ratio of the IHA group was significantly different than that of the LAPA group and the RAPA group(P<0.001).9 LAV/RAV ratio has good predictive value for unilateral aldosteronoma.The cut-off point of predicting the left APA is 1.246(AUC=0.870,P<0.001),the sensitivity is 90.5%and the specificity is 72.5%.The cut-off value of predicting the right APA is 0.993(AUC=0.808,P<0.001),the sensitivity is 87.5%and the specificity is 75.0%.10 The volume of the adrenal gland on the affected side of the CPA group was increased compared with the volume of the ipsilateral adrenal gland in the EH group and the NC group(P<0.001),and the volume of the adrenal gland on the contralateral side was reduced compared with the volume of the ipsilateral adrenal gland in the EH group(P<0.001).There was no significant difference between the groups(P>0.05).In the CPA group,there was no statistically significant correlation between AGV and 24-hour urine free cortisol(P>0.05).11 The volume of the affected adrenal gland in the PCC group was increased compared with the volume of the ipsilateral adrenal gland in the EH group and the NC group(P<0.001);the volume of the uninfected adrenal gland was not significantly different from the volume of the ipsilateral adrenal gland in the EH group(P>0.05),and it was increased compared with the NC group(P<0.001).conclusions1 This study provides a normal reference range for adrenal gland volume.2 There are physiological differences in the volume of the adrenal glands on the left and right sides.There are gender differences in the volume of the adrenal glands between men and women.The volume of the adrenal glands peaks at 29-40 years old and begins to decrease after 60 years of age.3 The total volume of the bilateral adrenal glands increases,which has a good value for the identification of adrenal hypertension.4 The ratio of left/right adrenal gland volume can be used as one of the indicators for predicting unilateral aldosteronoma. |
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