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通过质谱测量解决矛盾的双边阿尔多斯特抑制

Taweesak Wannachalee^1,2, Peeradon Vibhatavata^1,3, Sonja Konzen¹

¹Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI 48109, United States.

European journal of endocrinology

|April 15, 2025

概括

在上腺静脉采样 (AVS) 中,矛盾的双边阿尔多素抑制 (BAS) 通常是免疫测试的工件,而不是真正的荷尔蒙失衡. 这一发现影响了诊断原发性阿尔多斯顿主义 (PA) 侧面化.

科学领域:

内分泌学在内分泌学.
临床化学临床化学
医学诊断医学诊断医学诊断

背景情况:

上腺静脉采样 (AVS) 是确定原发性阿尔多斯特隆症 (PA) 的黄金标准.
矛盾的双边阿尔多素抑制 (BAS) 是一种在AVS期间观察到的鲜为人知的现象.
导致BAS的原因及其对PA诊断的影响需要进一步调查.

研究的目的:

通过使用临床免疫测试来确定AVS中BAS的患病率,使用或不使用可辛特罗宾刺激.
通过液体染色学质谱法 (LC-MS/MS) 验证BAS的发现.
为了澄清PA亚型中明显的BAS的诊断含义.

主要方法:

从402名PA患者 (2015-2023) 的AVS数据的回顾性分析.
在Cosyntropin刺激之前和之后进行AVS.
通过免疫试验和LC-MS/MS量化的阿尔多斯特和皮质醇水平.

主要成果:

在25%的患者中通过免疫测试观察到BAS.
经过LC-MS/MS分析,79%的受试患者没有BAS.
免疫测试显示,在定量皮质醇和阿尔多素方面存在显著的不准确性,特别是在上腺静脉中发现的高度时.

结论:

在AVS期间明显的BAS在很大程度上是临床免疫试验的工件.
这些发现在解释阿尔多激素抑制时需要谨慎,因为这表明了逆侧侧化,特别是在低于最佳的AVS导管治疗中.
准确的荷尔蒙量化对于可靠的PA亚型确定至关重要.

关键词:

上腺上腺上腺上腺静脉采样阿尔多斯氨酸是一种阿尔多斯氨酸.质谱测量质谱测量质谱测量质谱测量质量测量质谱测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量质量测量主要的阿尔多斯顿主义.

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