|Title:||Preoperative Diagnosis and Localization of Aldosterone-Producing Adenoma by Adrenal Venous Sampling after Administration of Metoclopramide
|Keywords:||primary aldosteronism;aldosterone-producing adenoma;adrenal venous sampling;metoclopramide;PRIMARY HYPER-ALDOSTERONISM;PLASMA-ALDOSTERONE||Issue Date:||2001||Journal Volume:||v.100||Journal Issue:||n.9||Start page/Pages:||598-603||Source:||JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION||Abstract:||
Background and purpose: Adrenal venous sampling is the most reliable test to distinguish aldosterone-producing adenoma ( APA) front idiopathic hyperaldosteronism (IHA). The diagnostic accuracy call be improved by), administration of adrenocorticotropin to minimize pulsatile secretion of aldosterone. Metoclopramide (MCP), a dopamine antagonist, can increase aldosterone secretion promptly without affecting cortisol secretion, This study investigated the diagnostic accuracy of adrenal venous sampling after MCP injection for the preoperative diagnosis and localization of APA . Methods: Prospective diagnosis and adrenalectomy was based oil adrenal venous sampling in 23 patients,,with a diagnosis of primary aldosteronism. Plasma aldosterone concentrations from adrenal veins and the inferior vena cir, it were measured before and 30 minutes after intravenous administration of 10 mg MCP. The ratio of bilateral adrenal venous aldosterone concentrations after MCP was used for diagnosis its follows: a ratio greater than 5 indicated APA, less than 3 indicated IHA, 3-5 indicated an intermediate diagnosis. Results: Catheterization of the right adrenal vein was unsuccessful in three patients. Twelve of 13 patients with all aldosterone ratio greater than 5 after MCP underwent unilateral adrenalectomy, and APA was confirmed in 11 of these patients. One patient with all intermediate diagnosis also had surgically confirmed APA, Six patients had a ratio less than 3. Before MCP administration, 10 of 13 patients with APA had it ratio greater than 5, and three patients had it ratio between 3 and 5: one patient with IHA had a ratio greater than 5. MCP improved the diagnosis of APA to im accuracy of 92% (12/13). Correct diagnosis of APA based oil computerized tomography (CT) was 85% (11/13). There was discordance between the Findings of adrenal venous sampling and CT in four of 20 patients, Conclusions: Administration of MCP to stimulate aldosterone secretion during adrenal venous sampling can improve the accuracy of differential diagnosis between APA and IHA.
|Appears in Collections:||醫學系|
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