The Clinical Value Of Adrenal Venous Sampling In Typing Diagnosis Of Primary Aldosteronism

Objective::To summarize and analyze the application value of adrenal venous sampling(AVS)in the diagnosis of primary aldosteronism(PA).Methods: The hospitalization and follow-up data of 78 patients who were highly suspected of PA(102 cases)and underwent AVS in Houhu District of Wuhan Central Hospital from July 2018 to October 2022 were retrospectively analyzed.The results of 78 patients who underwent AVS were analyzed,including age,sex,systolic blood pressure,diastolic blood pressure,duration of hypertension,hypokalemia,basal aldosterone,basal renin activity,and captopril challenge test(CCT),adrenal computed tomography(CT),adrenal AVS and pathological results(16 cases).Results:(1)Among78 patients who underwent AVS(AVS group),63 patients with successful AVS were divided into two groups according to the presence or absence of dominant secretion:27 patients with successful intubation and dominant secretion were divided into group A,and 36 patients with successful intubation and no dominant secretion were divided into group B.16 patients in group A were treated with laparoscopic adrenalectomy.11 patients in group A and 36 patients in group B were treated with drugs according to blood pressure.Compared with group B,the rate of hypokalemia in group A was higher(63%vs36.1%,P=0.04),and the basal aldosterone level in group A was higher[167.90(123.90,211.90)vs134.5(102.05,165.75),P=0.01].However,age,sex,systolic blood pressure,diastolic blood pressure,duration of hypertension,basal renin activity,and aldosterone to renin ratio(ARR)had no significant difference(P=0.63,0.77,0.68,0.98,0.29,0.18,0.10 > 0.05).(2)The positive rate of CCT was 81.48%(22/27)in group A and 83.33%(30/36)in group B when aldosterone >110pg/ml was used as the positive standard.The positive rate of CCT was 74.07%(20/27)in group A and 69.44%(25/36)in group B when the inhibition rate of aldosterone after 2 hours of medication was less than 30%.(3)There were no obvious complications in 78 patients undergoing AVS,and the success rate of AVS intubation was 80.8%(63/78).The cannulation failure of AVS was mainly due to unsuccessful right adrenal venipuncture.(4)In group A,the aldosterone level of the dominant secretion side was higher than that of the non-dominant secretion side(P<0.01),and the difference was statistically significant.There was no significant difference in cortisol and selectivity index(SI)between the dominant secretion side and the non-dominant secretion side(P=0.06、0.10>0.05).In group B,there was no significant difference in cortisol,aldosterone and SI between the high aldosterone side and the low aldosterone side(P=0.97,0.09,0.65 > 0.05).(5)the consistency rate of CT and AVS in typing diagnosis of PA was 68.25%(43/63).Conclusions: 1.The diagnostic pathway of PA:The diagnostic pathway of PA:(1)history collection(2)Withdrawal of hormone drugs,selection of non-dihydropyridine calcium channel antagonist or alpha receptor blocker to lower blood pressure and correct hypokalemia(3)PA screening test(4)CCT and CT(5)AVS.2.Hypertensive patients with hypokalemia,high aldosterone and low renin are the best population for AVS selection,and hypertensive patients with positive CCT are also the population for AVS selection.3.The operation of AVS is relatively safe.4.The negative results of AVS are related to the success rate of intubation,laboratory testing,sample collection methods and other factors.5.The consistency rate of CT and AVS in the diagnosis of PA subtypes was 68.25%.If patients were treated only according to the results of CT,they would undergo unnecessary surgical treatment.