オオツキ　ミチオ   Michio Otsuki   大月　道夫    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Correlation Between Lateralization Index of Adrenal Venous Sampling and Standardized Outcome in Primary Aldosteronism.
掲載誌名	正式名：Journal of the Endocrine Society 略　 称：J Endocr Soc ISSNコード：24721972/24721972
掲載区分	国外
巻・号・頁	2(8),pp.893-902
著者・共著者	Umakoshi Hironobu, Tsuiki Mika, Yokomoto-Umakoshi Maki, Takeda Yoshiyu, Takashi Yoneda, Kurihara Isao, Itoh Hiroshi, Katabami Takuyuki, Ichijo Takamasa, Wada Norio, Shibayama Yui, Yoshimoto Takanobu, Ashida Kenji, Ogawa Yoshihiro, Kawashima Junji, Sone Masakatsu, Inagaki Nobuya, Takahashi Katsutoshi, Watanabe Minemori, Matsuda Yuichi, Kobayashi Hiroki, Shibata Hirotaka, Kamemura Kohei, Otsuki Michio, Fujii Yuichi, Yamamto Koichi, Ogo Atsushi, Okamura Shintaro, Miyauchi Shozo, Fukuoka Tomikazu, Izawa Shoichiro, Yanase Toshihiko, Hashimoto Shigeatsu, Yamada Masanobu, Yoshikawa Yuichiro, Kai Tatsuya, Suzuki Tomoko, Kawamura Takashi, Naruse Mitsuhide
発行年月	2018/08
概要	Objectives:The aim of this study was to investigate the impact of adrenal venous sampling (AVS) lateralization cutoffs on surgical outcomes.Patients and Methods:Cosyntropin-stimulated AVS was used to guide surgical management of 377 patients with primary aldosteronism (PA) who were evaluated 6 months after surgery.Main Outcome Measures:The proportion of patients that achieved clinical benefit and complete biochemical success based on the AVS aldosterone lateralization index (LI) was determined.Results:Clinical benefit was achieved in 29 of 47 patients with an LI between 2 and 4, in 66 of 101 with an LI between 4 and 10, and in 158 of 203 with an LI > 10 (P < 0.01 for trend). Complete biochemical success was achieved in 27 of 42 with an LI between 2 and 4, in 60 of 76 with an LI between 4 and 10, and in 127 of 155 with an LI > 10 (P = 0.024 for trend). After adjustment for confounders and using those patients with an LI between 2 and 4 as a reference, a clinical benefit was associated only with those with an LI > 10 (OR, 2.30; 95% CI, 1.03 to 5.16), whereas complete biochemical success was associated with those with an LI between 4 and 10 (OR, 2.83; 95% CI, 1.14 to 7.01) or LI > 10 (OR, 3.55; 95% CI, 1.47 to 8.55).Conclusions:Difference of clinical outcome was relatively small when strict LI diagnostic threshold was used; biochemical cure was sufficiently achieved when an LI > 4 was used. Our study by standardized outcome measures validated that an LI > 4 may be appropriate for determining unilateral disease in PA.
DOI	10.1210/js.2018-00055
PMID	30057970