The Evidence-Based Medcine Of AVS For Primary Aldosteronism Classification Diagnosis

ObjectivePrimary aldosteronism(PA)or Conn syndrome,adrenal disease which was initially reported and named by conn in 1955,is characterised by hypertension,hypokalemia and metabolic alkalosis resulting from the hypersecretion of the adrenal mineralocorticoid aldosterone.Primary aldosteronism is currently considered as the most common cause of secondary hypertension,and accounts for 5 – 11% of unselected hypertensive patients.The most common sub-types of Primary aldosteronism include aldosterone-producing adenoma,bilateral adrenal hyperplasia and unilateral adrenal hyperplasia.More than 95% of cases of primary aldosteronism result from an aldosterone-producing adenoma and bilateral adrenal hyperplasia.Moreover,the treatment options primarily depend on whether the PA is unilateral or bilateral.In patients with unilateral hyperaldosteronism,surgical treatment is commonly indicated,as 30 – 60% of patients can be cured of hypertension after unilateral adrenalectomy.In contrast,patients with bilateral adrenal hyperplasia usually receive long-term medical treatment,such as mineralocorticoid receptor antagonist therapy.So it is crucial to distinguish what subtype of Primary aldosteronism for the treatment.computed tomography and adrenal venous sampling are the most common ways in diagnosis of adrenal hyperaldosteronism,Therefore,adrenal venous sampling is currently recognized as the gold standard for determining the laterality of Primary aldosteronism,this study is done to evaluate whether the assays of adrenal venous sampling fulfill the criteria of evidence.Comparing the sensitivity and specificity between computed tomography and adrenal venous sampling,and recommend the best way of inspecting.MethodsSystematically retrieved the literature which incloude primary aldosteronism,adrenal venous sampling and the diagnosis of primary aldosteronism,we applied the following inclusion and exclusion criteria to screen the relevant articles and extracted the date about adrenal venous sampling,then we used the software of meta-disc to analyze the statistics.ResultsAmong the 3303 relevant articles,we have carefully read the abstracts,full-texts of the articles and on the basis of inclusion and exclusion criteria,finally we screenedtwelve articles,ten of English and two of Chinese,involved 831 patients,a totally of755 patients had bilateral adrenal venous sampling,747 patients with bilateral adrenal CT examination,Meta analysis showed:1.AVS has a certain significance in the classification diagnosis of PA.2.The diagnosis coincidence rate of AVS in patients with diameter < 1 cm of APA and BAH is higher than that of CT(AVS>76%,CT<50%,p<0.05),Only based on computed tomography alone is not reliable,which may result in misdiagnosis,So we suggest that the patient who well accept adrenalectomy should have finished adrenal venous sampling.3.The diagnosis coincidence rate of CT in patients with diameter >1 cm of APA is higher than that of AVS(CT>95%,AVS<78.7,p<0.05),in most cases can direct the surgical treatment.4.The diagnosis coincidence rate of AVS is higher than that of CT(AVS93.6%,CT 37.4%,p<0.01)in patients with bilateral adrenal hyperplasia.5.The diagnosis coincidence rate of AVS is higher than that of CT(AVS 82.9%,CT68.9,p<0.05),in patients with unilateral adrenal hyperplasia.Conclusions1.Adrenal venous sampling(AVS)has a certain significance in the classification diagnosis of primary aldosteronism.2.The diagnosis coincidence rate of AVS in patients with diameter < 1 cm of APA is higher than that of CT(AVS>76%,CT<50%,p<0.01),Only based on computed tomography alone is not reliable,which may result in misdiagnosis,So we suggest that the patient who well accept adrenalectomy should have finished adrenal venous sampling.3.The diagnosis coincidence rate of CT in patients with diameter >1 cm of APA and BAH is higher than that of AVS(CT>95%),Combination with the determination of the patient's clinical symptoms and blood PAC and PRA values,After reasonable preoperative decompression and potassium supplement treatment in most cases can direct the surgical treatment.4.The diagnosis coincidence rate of AVS is higher than that of CT(AVS 93.6%,CT 37.4%,p<0.01)in patients with bilateral adrenal hyperplasia.Thoese patients should have complete AVS.5.We suggest patients with unilateral adrenal hyperplasia when the diameter should have AVS.6.As an invasive examination,which needs high operation requirement,and the price of whom is more expensive,the AVS only has been carried out in a few large medical institutions,and CT examination is a noninvasive examination,which can generally carried out in most medical institutions.So CT examination is the first choice for patients with PA diagnosis.In short,as a clinical doctor,we should combine patient's clinical symptoms and blood biochemical changes to choose a more reasonable examination and treatment plan for patients,and avoid to bring unnecessary economic burden and physical trauma to patients.