{"title":"在原发性醛固酮增多症中,有和没有矿化皮质激素受体拮抗剂的肾上腺静脉取样结果。","authors":"Sittikul Thipbumrung, Worapaka Manosroi","doi":"10.1186/s12902-025-01987-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend discontinuing mineralocorticoid receptor antagonists (MRA) at least 4 weeks before adrenal venous sampling (AVS) in primary aldosteronism (PA) to avoid interference with the lateralization index (LI). However, discontinuing MRA can cause hypertension and hypokalemia. This study aimed to evaluate the impact of continuing MRA use prior to AVS.</p><p><strong>Methods: </strong>A 5-year retrospective cohort study of patients aged ≥ 18 with PA who underwent successful AVS was conducted. Patients were divided into two groups: those who continued MRA during AVS and those who discontinued it for at least 4 weeks prior. Outcomes included differences in LI, plasma renin activity (PRA) levels before AVS, and post-adrenalectomy outcomes. Linear regression analysis clustered by subtypes of PA was used to adjust for confounders.</p><p><strong>Results: </strong>A total of 66 patients were included, with 30 (45.5%) in the continued MRA group and 36 (54.5%) in the discontinued MRA group. After adjustment for confounders, PRA levels before AVS showed no significant difference between the groups (β-coefficient 0.5, 95% CI -2.0 to 3.0; p = 0.239) and there was no significant difference in the LI between the continued and discontinued MRA groups (β-coefficient 7.9, 95% CI -27.8 to 43.7; p = 0.216). Clinical and biochemical success after unilateral adrenalectomy were similar between the two groups (p = 0.141 and p = 0.596, respectively).</p><p><strong>Conclusion: </strong>Continuing MRA prior to AVS did not appear to affect the interpretation of lateralization and may be a reasonable option for patients at high risk of complications from MRA withdrawal. Further prospective studies are needed to confirm these observations.</p>","PeriodicalId":9152,"journal":{"name":"BMC Endocrine Disorders","volume":"25 1","pages":"165"},"PeriodicalIF":2.8000,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219769/pdf/","citationCount":"0","resultStr":"{\"title\":\"Adrenal venous sampling outcomes with and without mineralocorticoid receptor antagonists in primary aldosteronism.\",\"authors\":\"Sittikul Thipbumrung, Worapaka Manosroi\",\"doi\":\"10.1186/s12902-025-01987-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Current guidelines recommend discontinuing mineralocorticoid receptor antagonists (MRA) at least 4 weeks before adrenal venous sampling (AVS) in primary aldosteronism (PA) to avoid interference with the lateralization index (LI). However, discontinuing MRA can cause hypertension and hypokalemia. This study aimed to evaluate the impact of continuing MRA use prior to AVS.</p><p><strong>Methods: </strong>A 5-year retrospective cohort study of patients aged ≥ 18 with PA who underwent successful AVS was conducted. Patients were divided into two groups: those who continued MRA during AVS and those who discontinued it for at least 4 weeks prior. Outcomes included differences in LI, plasma renin activity (PRA) levels before AVS, and post-adrenalectomy outcomes. Linear regression analysis clustered by subtypes of PA was used to adjust for confounders.</p><p><strong>Results: </strong>A total of 66 patients were included, with 30 (45.5%) in the continued MRA group and 36 (54.5%) in the discontinued MRA group. After adjustment for confounders, PRA levels before AVS showed no significant difference between the groups (β-coefficient 0.5, 95% CI -2.0 to 3.0; p = 0.239) and there was no significant difference in the LI between the continued and discontinued MRA groups (β-coefficient 7.9, 95% CI -27.8 to 43.7; p = 0.216). Clinical and biochemical success after unilateral adrenalectomy were similar between the two groups (p = 0.141 and p = 0.596, respectively).</p><p><strong>Conclusion: </strong>Continuing MRA prior to AVS did not appear to affect the interpretation of lateralization and may be a reasonable option for patients at high risk of complications from MRA withdrawal. Further prospective studies are needed to confirm these observations.</p>\",\"PeriodicalId\":9152,\"journal\":{\"name\":\"BMC Endocrine Disorders\",\"volume\":\"25 1\",\"pages\":\"165\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-07-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219769/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Endocrine Disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12902-025-01987-0\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Endocrine Disorders","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12902-025-01987-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
摘要
背景:目前的指南建议在原发性醛固酮增生症(PA)患者进行肾上腺静脉取样(AVS)前至少4周停用矿化皮质激素受体拮抗剂(MRA),以避免干扰侧化指数(LI)。然而,停用MRA可引起高血压和低钾血症。本研究旨在评估在AVS之前继续使用MRA的影响。方法:对年龄≥18岁的PA患者进行5年回顾性队列研究。患者被分为两组:在AVS期间继续MRA治疗的患者和在AVS前至少4周停止MRA治疗的患者。结果包括LI、AVS前血浆肾素活性(PRA)水平和肾上腺切除术后结果的差异。采用按PA亚型聚类的线性回归分析来调整混杂因素。结果:共纳入66例患者,其中持续MRA组30例(45.5%),停止MRA组36例(54.5%)。校正混杂因素后,AVS前PRA水平各组间无显著差异(β-系数0.5,95% CI -2.0 ~ 3.0;p = 0.239),继续和停止MRA组之间LI无显著差异(β系数7.9,95% CI -27.8至43.7;p = 0.216)。两组患者单侧肾上腺切除术后的临床和生化成功率相似(p = 0.141和p = 0.596)。结论:在AVS之前继续MRA似乎不会影响侧化的解释,对于MRA停药并发症高风险的患者可能是一个合理的选择。需要进一步的前瞻性研究来证实这些观察结果。
Adrenal venous sampling outcomes with and without mineralocorticoid receptor antagonists in primary aldosteronism.
Background: Current guidelines recommend discontinuing mineralocorticoid receptor antagonists (MRA) at least 4 weeks before adrenal venous sampling (AVS) in primary aldosteronism (PA) to avoid interference with the lateralization index (LI). However, discontinuing MRA can cause hypertension and hypokalemia. This study aimed to evaluate the impact of continuing MRA use prior to AVS.
Methods: A 5-year retrospective cohort study of patients aged ≥ 18 with PA who underwent successful AVS was conducted. Patients were divided into two groups: those who continued MRA during AVS and those who discontinued it for at least 4 weeks prior. Outcomes included differences in LI, plasma renin activity (PRA) levels before AVS, and post-adrenalectomy outcomes. Linear regression analysis clustered by subtypes of PA was used to adjust for confounders.
Results: A total of 66 patients were included, with 30 (45.5%) in the continued MRA group and 36 (54.5%) in the discontinued MRA group. After adjustment for confounders, PRA levels before AVS showed no significant difference between the groups (β-coefficient 0.5, 95% CI -2.0 to 3.0; p = 0.239) and there was no significant difference in the LI between the continued and discontinued MRA groups (β-coefficient 7.9, 95% CI -27.8 to 43.7; p = 0.216). Clinical and biochemical success after unilateral adrenalectomy were similar between the two groups (p = 0.141 and p = 0.596, respectively).
Conclusion: Continuing MRA prior to AVS did not appear to affect the interpretation of lateralization and may be a reasonable option for patients at high risk of complications from MRA withdrawal. Further prospective studies are needed to confirm these observations.
期刊介绍:
BMC Endocrine Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of endocrine disorders, as well as related molecular genetics, pathophysiology, and epidemiology.