意外发现与有症状的醛固酮瘤临床特征比较
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摘要
目的比较意外发现的醛固酮瘤(AIAPA)与因症状就诊而诊断为醛固酮瘤(SAPA)的患者的临床特征,为该疾病早期诊断提供依据。方法对中山大学附属第一医院2006年6月至2013年6月收治的确诊为醛固酮瘤的142例患者进行回顾性分析。其中因肾上腺意外瘤而就诊的26例患者为AIAPA组,因临床症状就诊的116例患者为SAPA组,比较两组患者的各项临床特征。结果 AIAPA组患者的年龄、血钾分别为(51.5±14.1)岁、(2.86±0.87) mmol/L,均明显高于SAPA组患者的(44.4±11.4)岁、(2.38±0.65) mmol/L,AIAPA组患者的收缩压、舒张压、术前所需螺内酯量中位数分别为(171±25) mmHg、(103±20) mmHg、240 mg/d,均明显低于SAPA组患者的(187±25) mmHg、(114±16) mmHg、320 mg/d,差异均有统计学意义(P<0.05);两组患者的性别、高血压家族史、尿钾水平、血脂谱、血醛固酮浓度、血肾素活性和肾上腺肿瘤直径比较差异均无统计学意义(P>0.05);多元线性相关分析结果显示,血钾水平分别与肾上腺肿瘤直径[r=-0.282,95%CI (-0.096,-0.584),P=0.026]和基线血浆醛固酮水平[r=-0.263,95%CI (-0.047,-0.514),P=0.036]呈负相关;多元线性回归分析发现仅有肿瘤直径(F=7.02,R2=0.184,P=0.003)与低钾血症相关。结论与因症状就诊而诊断为醛固酮瘤患者比较,以肾上腺意外瘤就诊而诊断为醛固酮瘤患者年龄更大、血钾水平更高、血压更低、低血钾患病率更低、术前螺内酯的使用量更小;对高血压患者常规进行血钾检测有利于早期发现症状不明显的醛固酮瘤患者。
Objective To compare the clinical features of aldosterone producing adenoma as adrenal incidentaloma(AIAPA) and symptomatic treatment of symptomatic aldosterone producing adenoma(SAPA), and to provide evidence for early diagnosis of the disease. Methods A retrospective analysis was performed on 142 patients diagnosed with aldosteronoma admitted to the First Affiliated Hospital of Sun Yat-sen University from June 2006 to June 2013.Among them, 26 patients who were diagnosed with adrenal accidental tumors were included in the AIAPA group, and116 patients who were treated for clinical symptoms were in included in the SAPA group. The clinical characteristics of the two groups were compared. Results The age and serum potassium of AIAPA patients were(51.5±14.1) years old,(2.86 ± 0.87) mmol/L, significantly higher than(44.4 ± 11.4) years old,(2.38 ± 0.65) mmol/L of SAPA patients. Systolic blood pressure, diastolic blood pressure, and median preoperative required spironolactone levels in AIAPA patients were(171±25) mmHg,(103±20) mmHg, 240 mg/d, significantly lower than(187±25) mmHg,(114±16) mmHg, 320 mg/d in SAPA patients(P<0.05). There were no significant differences in gender ratio, family history of hypertension, urinary potassium level, blood lipid profile, blood aldosterone concentration, blood renin activity, and adrenal tumor diameter(P>0.05). Multiple linear correlation analysis showed that serum potassium levels were negatively correlated adrenal tumor diameters(r=-0.282, 95% CI [-0.096,-0.584], P=0.026), and baseline plasma aldosterone levels(r=-0.263, 95% CI[-0.047,-0.514], P=0.036). Multiple linear regression analysis found that only tumor diameter was associated with hypokalemia(F=7.02, R2=0.184, P=0.003). Conclusion Compared with patients diagnosed as aldosteronism because of symptoms, patients diagnosed as aldosteronism by adrenal accidental tumors were older, had higher serum potassium level, lower blood pressure, lower prevalence of hypokalemia, and lower preoperative use of spironolactone. Regular blood potassium testing in patients with hypertension is beneficial for early detection of patients with aldosteronoma whose symptoms are not obvious.
Objective To compare the clinical features of aldosterone producing adenoma as adrenal incidentaloma(AIAPA) and symptomatic treatment of symptomatic aldosterone producing adenoma(SAPA), and to provide evidence for early diagnosis of the disease. Methods A retrospective analysis was performed on 142 patients diagnosed with aldosteronoma admitted to the First Affiliated Hospital of Sun Yat-sen University from June 2006 to June 2013.Among them, 26 patients who were diagnosed with adrenal accidental tumors were included in the AIAPA group, and116 patients who were treated for clinical symptoms were in included in the SAPA group. The clinical characteristics of the two groups were compared. Results The age and serum potassium of AIAPA patients were(51.5±14.1) years old,(2.86 ± 0.87) mmol/L, significantly higher than(44.4 ± 11.4) years old,(2.38 ± 0.65) mmol/L of SAPA patients. Systolic blood pressure, diastolic blood pressure, and median preoperative required spironolactone levels in AIAPA patients were(171±25) mmHg,(103±20) mmHg, 240 mg/d, significantly lower than(187±25) mmHg,(114±16) mmHg, 320 mg/d in SAPA patients(P<0.05). There were no significant differences in gender ratio, family history of hypertension, urinary potassium level, blood lipid profile, blood aldosterone concentration, blood renin activity, and adrenal tumor diameter(P>0.05). Multiple linear correlation analysis showed that serum potassium levels were negatively correlated adrenal tumor diameters(r=-0.282, 95% CI [-0.096,-0.584], P=0.026), and baseline plasma aldosterone levels(r=-0.263, 95% CI[-0.047,-0.514], P=0.036). Multiple linear regression analysis found that only tumor diameter was associated with hypokalemia(F=7.02, R2=0.184, P=0.003). Conclusion Compared with patients diagnosed as aldosteronism because of symptoms, patients diagnosed as aldosteronism by adrenal accidental tumors were older, had higher serum potassium level, lower blood pressure, lower prevalence of hypokalemia, and lower preoperative use of spironolactone. Regular blood potassium testing in patients with hypertension is beneficial for early detection of patients with aldosteronoma whose symptoms are not obvious.
引文
[1] MONTICONE S, BURRELLO J, TIZZANI D, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice[J]. J Am Coll Cardiol, 2017, 69:1811-1820.
[2] TONG A, JIA A, YAN S, et al. Ectopic cortisol-producing adrenocortical adenoma in the renal hilum:histopathological features and steroidogenic enzyme profile[J]. Int J Clin Exp Pathol, 2014, 7(7):4415-4421.
[3] POGORZELSKI R, TOUTOUNCHI S, KRAJEWSKA E, et al. The usefulness of laparoscopic adrenalectomy in the treatment of adrenal neoplasms-a single-centre experience[J]. Endokrynol Pol, 2017, 68(4):407-410.
[4] CHEN W1, LI F, CHEN D, et al. Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor:a meta-analysis[J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(2):121-127.
[5] STOWASSER M. Update in primary aldosteronism[J]. J Clin Endocrinol Metab, 2009, 94:3623-3630.
[6]张炜,汤正义,王卫庆,等.肾上腺意外瘤中醛固酮瘤患者的临床和生化特征[J].上海交通大学学报(医学版), 2006, 26(8):906-908.
[7] NISHIKAWA T, OMURA M, SATOH F, et al. Task Force Committee on Primary Aldosteronism(2011)The Japan Endocrine Society Guidelines for the diagnosis and treatment of primary aldosteronism—the Japan Endocrine Society 2009[J]. Endocr J, 58(9):711-721.
[8] MONTICONE S, D'ASCENZO F, MORETTI C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension:a systematic review and meta-analysis[J]. Lancet Diabetes Endocrinol, 2018, 6(1):41-50.
[9] YOUNG JR JF. The incidentally discovered adrenal mass[J]. N Engl J Med, 2007, 356:601-610.
[10] TUMORS FASSNACHT M, ARLT W, BANCOS I, et al. Management of adrenal incidentalomas:European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal[J]. Eur J Endocrinol, 2016, 175(2):G1-G34.
[11] STAVROPOULOS K, IMPRIALOS KP, KATSIKI N, et al. Primary aldosteronism in patients with adrenal incidentaloma:is screening appropriate for everyone?[J] J Clin Hypertens(Greenwich), 2018, 20(5):942-948.
[12] MANTERO F, TERZOLO M, ARNALDI G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology[J]. J Clin Endocrinol Metab, 2000,85(2):637-644.
[13] BERNINI G, MORETTI A, ARGENIO G, et al. Primary aldosteronism in normokalemic patients with adrenal incidentalomas[J]. Eur J Endocrinol, 2002, 146(4):523-529.
[14] VIERHAPPER H. Determination of the aldosterone/renin ratio in269 patients with adrenal incidentaloma[J]. Exp Clin Endocrinol Diabetes, 2007, 115(8):518-521.
[15] MULATERO P, MONTICONE S, BURRELLO J, et al. Guidelines for primary aldosteronism:uptake by primary care physicians in Europe[J]. J Hypertens, 2016, 34(11):2253-2257.
[16] FUNDER JW, CAREY RM, MANTERO F, et al. The management of primary aldosteronism:case detection, diagnosis, and treatment:An Endocrine Society Clinical Practice Guideline[J]. J ClinEndocrinol Metab, 2016, 101(5):1889-1916.
[17] ROSSI GP, BERNINI G, DESIDERI G, et al. Renal damage in primary aldosteronism:results of the PAPY Study[J]. Hypertension, 2006,48(2):232-238.
[18] TERZOLO M, STIGLIANO A, CHIODINI I, et al. AME position statement on adrenal incidentaloma[J]. Eur J Endocrinol, 2011, 164(6):851-870.
[2] TONG A, JIA A, YAN S, et al. Ectopic cortisol-producing adrenocortical adenoma in the renal hilum:histopathological features and steroidogenic enzyme profile[J]. Int J Clin Exp Pathol, 2014, 7(7):4415-4421.
[3] POGORZELSKI R, TOUTOUNCHI S, KRAJEWSKA E, et al. The usefulness of laparoscopic adrenalectomy in the treatment of adrenal neoplasms-a single-centre experience[J]. Endokrynol Pol, 2017, 68(4):407-410.
[4] CHEN W1, LI F, CHEN D, et al. Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor:a meta-analysis[J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(2):121-127.
[5] STOWASSER M. Update in primary aldosteronism[J]. J Clin Endocrinol Metab, 2009, 94:3623-3630.
[6]张炜,汤正义,王卫庆,等.肾上腺意外瘤中醛固酮瘤患者的临床和生化特征[J].上海交通大学学报(医学版), 2006, 26(8):906-908.
[7] NISHIKAWA T, OMURA M, SATOH F, et al. Task Force Committee on Primary Aldosteronism(2011)The Japan Endocrine Society Guidelines for the diagnosis and treatment of primary aldosteronism—the Japan Endocrine Society 2009[J]. Endocr J, 58(9):711-721.
[8] MONTICONE S, D'ASCENZO F, MORETTI C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension:a systematic review and meta-analysis[J]. Lancet Diabetes Endocrinol, 2018, 6(1):41-50.
[9] YOUNG JR JF. The incidentally discovered adrenal mass[J]. N Engl J Med, 2007, 356:601-610.
[10] TUMORS FASSNACHT M, ARLT W, BANCOS I, et al. Management of adrenal incidentalomas:European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal[J]. Eur J Endocrinol, 2016, 175(2):G1-G34.
[11] STAVROPOULOS K, IMPRIALOS KP, KATSIKI N, et al. Primary aldosteronism in patients with adrenal incidentaloma:is screening appropriate for everyone?[J] J Clin Hypertens(Greenwich), 2018, 20(5):942-948.
[12] MANTERO F, TERZOLO M, ARNALDI G, et al. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology[J]. J Clin Endocrinol Metab, 2000,85(2):637-644.
[13] BERNINI G, MORETTI A, ARGENIO G, et al. Primary aldosteronism in normokalemic patients with adrenal incidentalomas[J]. Eur J Endocrinol, 2002, 146(4):523-529.
[14] VIERHAPPER H. Determination of the aldosterone/renin ratio in269 patients with adrenal incidentaloma[J]. Exp Clin Endocrinol Diabetes, 2007, 115(8):518-521.
[15] MULATERO P, MONTICONE S, BURRELLO J, et al. Guidelines for primary aldosteronism:uptake by primary care physicians in Europe[J]. J Hypertens, 2016, 34(11):2253-2257.
[16] FUNDER JW, CAREY RM, MANTERO F, et al. The management of primary aldosteronism:case detection, diagnosis, and treatment:An Endocrine Society Clinical Practice Guideline[J]. J ClinEndocrinol Metab, 2016, 101(5):1889-1916.
[17] ROSSI GP, BERNINI G, DESIDERI G, et al. Renal damage in primary aldosteronism:results of the PAPY Study[J]. Hypertension, 2006,48(2):232-238.
[18] TERZOLO M, STIGLIANO A, CHIODINI I, et al. AME position statement on adrenal incidentaloma[J]. Eur J Endocrinol, 2011, 164(6):851-870.