2017-08-012024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/691774摘要：原發性皮質醛酮症(primary aldosteronism, PA)起因於腎上腺皮質過度分泌醛固酮，病因主要分為兩類，腎上腺腺瘤(aldosterone-producing adenoma, APA)或腎上腺增生(idiopathic adrenalhyperplasia, IAH)所引起，前者治療方式為手術切除腎上腺，後者則以降高血壓藥物控制，正確區分此兩種原因是治療PA 的關鍵。臨床上通常以斷層掃描(computed tomography, CT)做腎上腺病灶的初步判定，但缺乏足夠的敏感度與特異性。目前區分PA 病因是以腎上腺靜脈血取樣(adrenal venous sampling, AVS)為標準診斷工具，但它具有侵襲性且操作上有難度，有一定比例會發生併發症，對預後的預測也未有定論。核子醫學的NP-59 腎上腺造影很早就被應用在PA 上，受限於影像解析度，通常被認為少有臨床應用價值；但在我們的研究發現，NP-59不但對於CT 或AVS 上無法判定的腎上腺腫瘤作出正確的病因分析，並且對於術後的預後預測具有優越的效果，半定量分析更能提供客觀的評估方式。此檢查在台大醫院自2001 開始執行，受檢人次逐年增加，2007 年達到高峰後卻開始下降，主因為受檢過程繁複且類固醇抑制可能造成暫時性的副作用。正子造影(positron emission tomography, PET)是一個具有更高解析度的核子醫學工具，放射性碳元素標定的metomidate (11C-metomidate, 11C-MTO)與醛固酮的合成有關，目前已開始應用在腎上腺造影，並被證實在區分腎上限病灶上有相當好的能力，但在PA 方面的研究不多，初步發現對於區分PA 有良好的準確率。鉀離子通道的KCNJ5 基因突變是近年來被注意的致病機轉，許多突變點陸續被發現，但對於PA 病因區分及預後的相關性仍未確立。本計畫的目的在於比對腎上腺靜脈血取樣以確立11C-MTO 區分PA 病因之準確度，並與KCNJ5 基因突變比對，判斷兩者的相關性。<br> Abstract: APA and IAH are two main etiologies of PA, and the former one can be cured by surgical removalof adrenal gland, while the later one should be treated medically. The initial approach to PA is CT,however, it lacks of sensitivity and specificity. AVS is the gold standard diagnostic tool for subtypedifferentiation. However, it is invasive, highly technical-dependent, potentially with complicationrisk and lack of evidence in predicting prognosis. NP-59 adrenal scintigrpahy has been applied in PAfor long, but it is considered as minor clinical advantage due to limited image resolution. However,TAIPAI group has published that NP-59 has excellent ability in differentiation the subtype for theequivocal lesions on CT and AVS and prognostic value after adrenalectomy, and semiquantificationapproach provides more objective evaluation method. The examination number of NP-59 adrenalscintigrpahy increased from 2001, reached to the peak in 2007, and declined gradually afterward.The main reason is long examination time and temporary side effect by dexamathasone used inNP-59 adrenal scintigrpahy. PET has higher resolution and better ability in clinical diagnosis.11C-MTO PET is associated with the synthesis of aldosterone and has been studied for adrenal glandlesions. It is proved that 11C-MTO PET has good ability to determine the nature of adrenal lesions.Although few data have been studied in PA, preliminary data revealed good accuracy in subtypedifferentiation. Recently KCNJ5 mutation of potassium channel is widely studied in PA, and morepoint mutations have been found. However, the relationship between KCNJ5mutation, subtypedifferentiation and prognostic value is not established. In our study, we attempt to compare thediagnostic accuracy of 11C-MTO PET in PA subtype differentiation with AVS and, its correlationwith KCNJ5 mutation.原發性皮質醛酮症11C-metomidate正子造影腎上腺靜脈血取樣KCNJ5primary aldosteronism11C-MetomidatePETadrenal venous samplingKCNJ5