| Background and purpose:Primary aldosteronism is one of the most common secondary hypertension at present.Compared with essential hypertension,it can cause more serious target organ damage.Therefore,early diagnosis has played a key role in treating the disease,but the diagnosis process of primary aldosteronism is complex,the detection methods are different and the diagnostic criteria are not standard,especially in the screening test of primary aldosteronism.The main methods to detect aldosterone and renin are chemiluminescence immunoassay?CLIA?and radioimmunoassay?RIA?.Adrenal vein sampling?AVS?is the only procedure to assess adrenal lateralization in patients with primary aldosteronism?PA?.PA patients without apparent aldosteronoma or with normal adrenal imaging frequently have unilateral aldosterone hypersecretion,and they are often prescribed medication or could bear inappropriate adrenalectomy in the absence of AVS.The diagnosis process of PA is full of doubts.This study aims to compare the sensitivity and specificity of CLIA and RIA in detection of aldosterone and renin,and to explore the optional detection methods and indicators for screening PA,moreover,to identify which clinical characteristics can recommend to perform AVS in PA patients without apparent aldosteronoma.Subjects:A cross-sectional study was carried on hypertension diagnosed in the department Hypertension and Endocrinology in Daping Hospital from February 2017 to December 2019.Object of the first part of the study:60 PA patients?with males accounting for 53.3%and at a median age of 50 years?,another baseline-matched 82 patients with essential hypertension?with males accounting for 50.0%and at a median age of 50 years?and 114 healthy controls?males accounting for 38.6%and at a median age of 46 years?at the same period were also recruited.Object of the second part of the study:181 PA patients without obvious adenoma were recruited,then divided into three groups according to imaging results:unilateral lesion group?with male accounting for 38.5%at a median age of 49 years?,bilateral lesion group?with male accounting for 62.0%at a median age of 55 years?and bilateral non lesion group?with male accounting for 50.0%at median age of 48 years?.Methods:General clinical data of all subjects were collected.Plasma aldosterone concentration and ratio of aldosterone/direct rennin concentration?ADRR?or the ratio of aldosterone/plasma rennin activity?ARR?were measured by CLIA and RIA respectively.Then Adrenal CT scan and AVS were performed.Results:?1?In chemiluminescence,the plasma aldosterone concentration of each group was significantly different?P<0.01?;the direct renin concentration of primary aldosteronism group was inhibited,which was lower than that of control group and essential hypertension group?P<0.01?.The plasma aldosterone concentration measured by radioimmunoassay had no statistical difference among these three groups?P=0.764?.The plasma renin activity was inhibited only in the primary aldosteronism group?P<0.01?.?2?There was a high correlation between plasma renin activity and direct renin concentration?r=0.8804,P<0.001?,but the correlation between plasma aldosterone concentration measured by the 2 methods was not good?r=0.3650,P<0.001?.If object was subdivided into primary aldosteronism group and healthy control group,the correlation of plasma aldosterone concentration in primary aldosteronism group was better than that in control group?P<0.01?.?3?The sensitivity of ADRR was highest?91.53%?among all screening indices,and the specificity of diagnosis was significantly improved by combining plasma aldosterone concentration?CLIA,96.49%?.?4?Among PA at an average age of 50 years,ADRR screening cut-off point was 12(pg·mL-1)/(?U·mL-1),and ARR screening cut-off point was 20(ng·dL-1)/(ng·mL-1·h-1).?5?The overall concordance rate between CT and AVS is 49.2%?89/181?,and 47.0%?85/181?of patients had unilateral adrenal hypersecretion in PA patients without apparent aldosteronoma.?6?ADRR or ARR after confirmatory test is highly related to adrenal laterality.The specificity of ADRR>100(pg·mL-1)/(?U·mL-1)after confirmatory test is 100%,while the specificity of ARR>80(ng·dL-1)/(ng·mL-1·h-1)along with hypokalemia and hypertension reached88%.?7?The effect of laterality on target organ damage was not significant,but patients with ADRR after confirmatory test>100(pg·mL-1)/(?U·mL-1)had higher peripheral aldosterone concentration and incidences of ischemic heart diseases and renal damage?P<0.05?.Conclusion?1?CLIA is superior to RIA in detection of screening indices for PA.?2?The diagnostic specificity of combined plasma aldosterone concentration?CLIA?and ADRR indices is the best.?3?Among PA at an average age of 50 years,ADRR screening cut-off point was 12(pg·mL-1)/(?U·mL-1),and ARR screening cut-off point was 20(ng·dL-1)/(ng·mL-1·h-1).?4?Proportions of unilateral adrenal hypersecretion were higher in PA patients without apparent aldosteronoma.?5?After confirmatory tests,ADRR>100(pg·mL-1)/(?U·mL-1)alone or ARR>80?ng dL-1?/?ng·mL-1·h-1?combined with hypertension and hypokalemia indicates adrenal laterality,increasing the cardiorenal damage.Thus,AVS should be highly recommended in these patients before considered surgery. |
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