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Feasibility of Imaging-Guided Adrenalectomy in Young Patients With Primary Aldosteronism
GP. Rossi, F. Crimì, G. Rossitto, L. Amar, M. Azizi, A. Riester, M. Reincke, C. Degenhart, J. Widimsky, M. Naruse, J. Deinum, LS. Kool, T. Kocjan, A. Negro, E. Rossi, G. Kline, A. Tanabe, F. Satoh, LC. Rump, O. Vonend, HS. Willenberg, PJ. Fuller,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, práce podpořená grantem
NLK
Free Medical Journals
od 1979 do Před 1 rokem
Open Access Digital Library
od 1979-01-01
Open Access Digital Library
od 1979-01-01
- MeSH
- adrenalektomie metody MeSH
- chirurgie s pomocí počítače MeSH
- dospělí MeSH
- hyperaldosteronismus diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nadledviny krevní zásobení MeSH
- odběr vzorku krve MeSH
- počítačová rentgenová tomografie MeSH
- retrospektivní studie MeSH
- studie proveditelnosti MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Many of the patients with primary aldosteronism (PA) are denied curative adrenalectomy because of limited availability or failure of adrenal vein sampling. It has been suggested that adrenal vein sampling can be omitted in young patients with a unilateral adrenal nodule, who show a florid biochemical PA phenotype. As this suggestion was based on a very low quality of evidence, we tested the applicability and accuracy of imaging, performed by computed tomography and/or magnetic resonance, for identification of unilateral PA, as determined by biochemical and/or clinical cure after unilateral adrenalectomy. Among 1625 patients with PA submitted to adrenal vein sampling in a multicenter multiethnic international study, 473 were ≤45 years of age; 231 of them had exhaustive imaging and follow-up data. Fifty-three percentage had a unilateral adrenal nodule, 43% had no nodules, and 4% bilateral nodules. Fifty-six percentage (n=131) received adrenalectomy and 128 were unambiguously diagnosed as unilateral PA. A unilateral adrenal nodule on imaging and hypokalemia were the strongest predictors of unilateral PA at regression analysis. Accordingly, imaging allowed correct identification of the responsible adrenal in 95% of the adrenalectomized patients with a unilateral nodule. The rate raised to 100% in the patients with hypokalemia, who comprised 29% of the total, but fell to 88% in those without hypokalemia. Therefore, a unilateral nodule and hypokalemia could be used to identify unilateral PA in patients ≤45 years of age if adrenal vein sampling is not easily available. However, adrenal vein sampling remains indispensable in 71% of the young patients, who showed no nodules/bilateral nodules at imaging and/or no hypokalemia. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01234220.
3rd Department of Medicine Charles University Prague General Hospital Czech Republic
AP HP Hôpital Européen Georges Pompidou Hypertension Department and DMU CARTE Paris France
Department of Endocrinology in Charlottenburg Berlin Germany
Department of Endocrinology North Western Medical University named after 1 I Mechnikov Russia
Department of Internal Medicine National Taiwan University Hospital Taipei
Department of Internal Medicine Radboud University Medical Center Nijmegen The Netherlands
Department of Medicine DIMED International PhD Program in Arterial Hypertension and Vascular Biology
Department of Medicine DIMED University of Padova Institute of Radiology University Hospital Italy
Department of Medicine Monash University Clayton Victoria Australia
Department of Nephrology Hypertension Unit Hosp del Mar Universitat Autònoma de Barcelona Spain
Department of Radiology Radboud University Medical Center Nijmegen The Netherlands
Division of Endocrinology and Metabolism Rostock University Medical Center Rostock Germany
Division of Nephrology Endocrinology and Vascular Medicine Tohoku University Hospital Sendai Japan
Endocrinology Unit Monash Health Clayton Victoria Australia
Faculty of Medicine University of Ljubljana Slovenia
Foothills Medical Centre University of Calgary Canada
Heinrich Heine University Düsseldorf Nephrologie Germany
Hudson Institute of Medical Research Clayton Victoria Australia
Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom
Medical College of Wisconsin Endocrinology Center North Hills Health Center Menomonee Falls
Medizinische Klinik und Poliklinik 4 Klinikum der Universität München LMU München Germany
Citace poskytuje Crossref.org
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