https://scholars.lib.ntu.edu.tw/handle/123456789/508363
標題: | Subtyping of primary aldosteronism in the AVIS-2 study: Assessment of selectivity and lateralization | 作者: | Rossitto G. Amar L. Azizi M. Riester A. Reincke M. Degenhart C. Widimsky J. Naruse M. Deinum J. Schultzekool L. Kocjan T. Negro A. Rossi E. Kline G. Tanabe A. Satoh F. Rump L.C. Vonend O. Willenberg H.S. Fuller P. Yang J. Chee N.Y.N. Magill S.B. Shafigullina Z. Quinkler M. Oliveras A. CHIN-CHEN CHANG VIN-CENT WU Somloova Z. Maiolino G. Battistel M. Battistel M. Lenzini L. Pessina A.C. Pessina A.C. Rossi G.P. |
公開日期: | 2020 | 卷: | 105 | 期: | 6 | 來源出版物: | Journal of Clinical Endocrinology and Metabolism | 摘要: | Context: Adrenal venous sampling (AVS) is the key test for subtyping primary aldosteronism(PA), but its interpretation varies widely across referral centers and this can adversely affect themanagement of PA patients.Objectives: To investigate in a real-life study the rate of bilateral success and identification ofunilateral aldosteronism and their impact on blood pressure outcomes in PA subtyped by AVS.Design and settings: In a retrospective analysis of the largest international registry of individual AVS data (AVIS-2 study), we investigated how different cut-off values of the selectivity index(SI) and lateralization index (LI) affected rate of bilateral success, identification of unilateralaldosteronism, and blood pressure outcomes.Results: AVIS-2 recruited 1625 individual AVS studies performed between 2000 and 2015 in 19tertiary referral centers. Under unstimulated conditions, the rate of biochemically confirmedbilateral AVS success progressively decreased with increasing SI cut-offs; furthermore, withcurrently used LI cut-offs, the rate of identified unilateral PA leading to adrenalectomy wasas low as <25%. A within-patient pairwise comparison of 402 AVS performed both underunstimulated and cosyntropin-stimulated conditions showed that cosyntropin increased theconfirmed rate of bilateral selectivity for SI cut-offs = 2.0, but reduced lateralization rates(P < 0.001). Post-adrenalectomy outcomes were not improved by use of cosyntropin or morerestrictive diagnostic criteria.Conclusion: Commonly used SI and LI cut-offs are associated with disappointingly low ratesof biochemically defined AVS success and identified unilateral PA. Evidence-based protocolsentailing less restrictive interpretative cut-offs might optimize the clinical use of this costly andinvasive test. ? 2020 Endocrine Society. All rights reserved. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/508363 | ISSN: | 0021-972X | DOI: | 10.1210/clinem/dgz017 | SDG/關鍵字: | metoclopramide; tetracosactide; hydrocortisone; hormone; tetracosactide; adrenal venous sampling; adrenalectomy; Article; blood pressure; controlled study; diagnostic value; disease classification; endocrine system examination; human; major clinical study; postoperative period; primary hyperaldosteronism; priority journal; receiver operating characteristic; retrospective study; sensitivity and specificity; treatment outcome; biochemical analysis; blood pressure measurement; blood sampling; cohort analysis; cost benefit analysis; diagnostic procedure; disease assessment; disease association; disease registry; evidence based practice; general pathological parameters; invasive procedure; lateralization index; outcome assessment; reference value; selectivity index; sensitivity analysis; study design; adrenal gland; classification; differential diagnosis; follow up; hyperaldosteronism; metabolism; pathology; prognosis; specimen handling; vascularization; Adrenal Glands; Adrenalectomy; Cosyntropin; Diagnosis, Differential; Follow-Up Studies; Hormones; Humans; Hyperaldosteronism; Prognosis; Retrospective Studies; Specimen Handling |
顯示於: | 法醫學科所 |
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