原発性アルドステロン症診断におけるACTH負荷副腎静脈サンプリング法の適応,意義および評価基準(原発性アルドステロン症診断の進歩-ACTH負荷副腎静脈サンプリング法の診断的意義,副腎静脈サンプリング研究会)

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Primary aldosteronism (PA) is characterized by hypertension, suppressed plasma renin activity, and excessive secretion of aldosterone. The diagnosis of PA consists of two steps, (1) screening of PA among hypertensive patients and (2)determination of laterality of excessive aldosterone secretion. Plasma aldosterone concentration/plasma renin activity ratio (ARR) is the most reliable method of screening for PA. Although ARR > 20-30 has been widely used for screening of PA, sustained suppression of plasma renin concentration under furosemide loading with upright posture should be confirmed for definitive diagnosis of PA. In the second step of PA diagnosis, adrenal CT scan, ^<131>I-adosterol adrenal scintigraphy, and urinary 18-hydroxycortisol measurements as well as ACTH-loading adrenal venous sampling (AVS) are performed for diagnosis of laterality. The AVS is useful in PA cases showing bilateral adrenal tumors, unilateral or bilateral micronodules, or normal CT scan. For PA cases with unilateral hypodense adrenal mass, results of other tests should be considered for indication of AVS. In addition, ACTH loading as well as basal values should also be performed upon AVS to minimize false-positive and false-negative modulations. To evaluate results of AVS, aldosterone/cortisol (A/C) ratio in the right and left adrenal veins should be compared to that in the inferior vena cava (IVC). The ACTH-loading AVS is a very powerful method to determine which side of the adrenals excrete excessive aldosterone; however, there are still limitations for differentiate laterality, therefore, comprehensive evaluation including other test is required.
東京女子医科大学の論文
2003-11-25

原発性アルドステロン症診断におけるACTH負荷副腎静脈サンプリング法の適応,意義および評価基準(原発性アルドステロン症診断の進歩-ACTH負荷副腎静脈サンプリング法の診断的意義,副腎静脈サンプリング研究会)

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