Furong He, Xizi Zhang, Yiyang Fu, Jun Yang, Zhipeng Du, Ying Song, Jinbo Hu, Qianna Zhen, Yifan He, Qifu Li, Wenwen He, Shumin Yang
{"title":"原发性醛固酮增多症患者的手术决定基于肾上腺静脉醛固酮未被皮质醇纠正。","authors":"Furong He, Xizi Zhang, Yiyang Fu, Jun Yang, Zhipeng Du, Ying Song, Jinbo Hu, Qianna Zhen, Yifan He, Qifu Li, Wenwen He, Shumin Yang","doi":"10.1007/s12020-025-04246-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cortisol-corrected aldosterone concentration is used to interpret adrenal venous sampling (AVS) results to identify the subtype of primary aldosteronism. Whether AVS could be interpreted using aldosterone without cortisol correction is unclear.</p><p><strong>Purpose: </strong>To evaluate the accuracy of plasma aldosterone concentration (PAC) and aldosterone ratio (PAC of the higher side divided by PAC of the lower side) of the adrenal veins for the diagnosis of unilateral PA (UPA).</p><p><strong>Methods: </strong>A retrospective study was conducted in PA patients who underwent bilaterally successful AVS. Area under the receiver operating characteristic curve (AUC), specificity and sensitivity of PAC and aldosterone ratio of adrenal veins in non-stimulated and adrenocorticotropic hormone (ACTH) - stimulated AVS were calculated.</p><p><strong>Results: </strong>323 patients with UPA and 122 with bilateral PA were included. Under non-ACTH stimulated AVS, AUC of PAC and aldosterone ratio to diagnose UPA were 0.86 (95%CI 0.83-0.89) and 0.84 (95%CI 0.80-0.88), respectively. The specificity was 90%, with sensitivity of 59%, when using PAC cutoff of 1012.8 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 65%, when using aldosterone ratio cutoff of 6.84 to diagnose UPA. Under ACTH stimulated AVS, PAC and aldosterone ratio showed similar accuracy to diagnose UPA. The specificity was 90%, with sensitivity of 60%, when using PAC cutoff of 4008.3 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 80%, when using aldosterone ratio cutoff of 4.77 to diagnose UPA.</p><p><strong>Conclusion: </strong>PAC and aldosterone ratio of the adrenal veins can be used to diagnose UPA during non-stimulated and ACTH-stimulated AVS.</p>","PeriodicalId":49211,"journal":{"name":"Endocrine","volume":" ","pages":"891-900"},"PeriodicalIF":2.9000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Surgical decision in patients with primary aldosteronism based on adrenal veins aldosterone not corrected by cortisol.\",\"authors\":\"Furong He, Xizi Zhang, Yiyang Fu, Jun Yang, Zhipeng Du, Ying Song, Jinbo Hu, Qianna Zhen, Yifan He, Qifu Li, Wenwen He, Shumin Yang\",\"doi\":\"10.1007/s12020-025-04246-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Cortisol-corrected aldosterone concentration is used to interpret adrenal venous sampling (AVS) results to identify the subtype of primary aldosteronism. Whether AVS could be interpreted using aldosterone without cortisol correction is unclear.</p><p><strong>Purpose: </strong>To evaluate the accuracy of plasma aldosterone concentration (PAC) and aldosterone ratio (PAC of the higher side divided by PAC of the lower side) of the adrenal veins for the diagnosis of unilateral PA (UPA).</p><p><strong>Methods: </strong>A retrospective study was conducted in PA patients who underwent bilaterally successful AVS. Area under the receiver operating characteristic curve (AUC), specificity and sensitivity of PAC and aldosterone ratio of adrenal veins in non-stimulated and adrenocorticotropic hormone (ACTH) - stimulated AVS were calculated.</p><p><strong>Results: </strong>323 patients with UPA and 122 with bilateral PA were included. Under non-ACTH stimulated AVS, AUC of PAC and aldosterone ratio to diagnose UPA were 0.86 (95%CI 0.83-0.89) and 0.84 (95%CI 0.80-0.88), respectively. The specificity was 90%, with sensitivity of 59%, when using PAC cutoff of 1012.8 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 65%, when using aldosterone ratio cutoff of 6.84 to diagnose UPA. Under ACTH stimulated AVS, PAC and aldosterone ratio showed similar accuracy to diagnose UPA. The specificity was 90%, with sensitivity of 60%, when using PAC cutoff of 4008.3 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 80%, when using aldosterone ratio cutoff of 4.77 to diagnose UPA.</p><p><strong>Conclusion: </strong>PAC and aldosterone ratio of the adrenal veins can be used to diagnose UPA during non-stimulated and ACTH-stimulated AVS.</p>\",\"PeriodicalId\":49211,\"journal\":{\"name\":\"Endocrine\",\"volume\":\" \",\"pages\":\"891-900\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Endocrine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12020-025-04246-3\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12020-025-04246-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/9 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Surgical decision in patients with primary aldosteronism based on adrenal veins aldosterone not corrected by cortisol.
Background: Cortisol-corrected aldosterone concentration is used to interpret adrenal venous sampling (AVS) results to identify the subtype of primary aldosteronism. Whether AVS could be interpreted using aldosterone without cortisol correction is unclear.
Purpose: To evaluate the accuracy of plasma aldosterone concentration (PAC) and aldosterone ratio (PAC of the higher side divided by PAC of the lower side) of the adrenal veins for the diagnosis of unilateral PA (UPA).
Methods: A retrospective study was conducted in PA patients who underwent bilaterally successful AVS. Area under the receiver operating characteristic curve (AUC), specificity and sensitivity of PAC and aldosterone ratio of adrenal veins in non-stimulated and adrenocorticotropic hormone (ACTH) - stimulated AVS were calculated.
Results: 323 patients with UPA and 122 with bilateral PA were included. Under non-ACTH stimulated AVS, AUC of PAC and aldosterone ratio to diagnose UPA were 0.86 (95%CI 0.83-0.89) and 0.84 (95%CI 0.80-0.88), respectively. The specificity was 90%, with sensitivity of 59%, when using PAC cutoff of 1012.8 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 65%, when using aldosterone ratio cutoff of 6.84 to diagnose UPA. Under ACTH stimulated AVS, PAC and aldosterone ratio showed similar accuracy to diagnose UPA. The specificity was 90%, with sensitivity of 60%, when using PAC cutoff of 4008.3 ng/dL to diagnose UPA. The specificity was 90%, with sensitivity of 80%, when using aldosterone ratio cutoff of 4.77 to diagnose UPA.
Conclusion: PAC and aldosterone ratio of the adrenal veins can be used to diagnose UPA during non-stimulated and ACTH-stimulated AVS.
期刊介绍：
Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology.
Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted.
Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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