ABSTRACT
CONTEXT: Adrenal vein sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism (PA), but accurate placement of the sampling catheter is technically challenging. Intraprocedural cortisol measurement can confirm the catheter's position, thereby increasing the AVS success rate. OBJECTIVE AND METHODS: We developed a quick cortisol assay (QCA) that uses immunochromatography and gold nanoparticles and can be performed either semiquantitatively or quantitatively. The assay was evaluated in two studies. In a single-center study, PA patients were assigned to undergo AVS incorporating the semiquantitative QCA (n = 30), the quantitative QCA (n = 30), or without the QCA (n = 30), and the rates of successful AVS were determined. In a prospective multicenter randomized, controlled study, the success rates of AVS performed with (n = 148) or without (n = 145) the semiquantitative QCA were determined. RESULTS: Cortisol concentrations were measured during AVS in 6 minutes or less in the radiology suite, without additional technical assistance, and significantly correlated with a conventional reference assay (R(2) = 0.994; P < .001). In the single-center study, the differences in the AVS success rates associated with semiquantitative and quantitative QCAs were not significant (both 93%); however, the success rates were significantly higher than the rate of successful AVS performed without using the QCA (63%; P < .001). The success rate of AVS performed in the multicenter study was 94% for the semiquantitative QCA, which was significantly higher than the rate for the patients without QCA (60%; P < .001). CONCLUSIONS: Our novel QCA was rapidly and easily performed at the point of care and improved the rate of successful AVS.
Subject(s)
Blood Specimen Collection/methods , Chromatography, Affinity/methods , Hydrocortisone/analysis , Hyperaldosteronism/diagnosis , Adrenal Glands/blood supply , Female , Gold , Humans , Hyperaldosteronism/blood , Male , Middle Aged , Nanoparticles , Point-of-Care Systems , Prospective StudiesABSTRACT
The mineralocorticoid receptor (MR) is expressed in the kidneys and in adipose tissue, and primary aldosteronism (PA) is associated with metabolic syndrome. This study assessed the effects of MR blockade by eplerenone (EPL) and spironolactone (SPL) on blood pressure (BP) and metabolic factors in patients with PA. Fifty-four patients with PA were treated with one of two MRAs, EPL (25-100 mg daily, n=27) or SPL (12.5-100 mg daily, n=27) for 12 months. Visceral (VAT) and subcutaneous adipose tissue were quantified using CT and FatScan imaging analysis software. Body mass index, homeostasis model assessment-insulin resistance (HOMA-IR), serum creatinine, potassium and lipids, urinary albumin excretion (UAE) and plasma aldosterone concentration (PAC) and plasma renin activity (PRA) were measured before and after treatment. EPL and SPL decreased BP and increased serum potassium levels to similar degrees. PAC and PRA did not differ between the two groups. Although treatment with the MRAs did not change HOMA-IR or serum lipids, they significantly decreased UAE and VAT (P<0.05). These results suggest that EPL and SPL are effective and safe for the treatment of PA. The long-term metabolic and renal effects of these MRAs should be further investigated.
Subject(s)
Hyperaldosteronism/drug therapy , Mineralocorticoid Receptor Antagonists/therapeutic use , Spironolactone/analogs & derivatives , Spironolactone/therapeutic use , Adult , Aged , Blood Pressure/drug effects , Eplerenone , Female , Humans , Kidney Function Tests , Male , Middle Aged , Mineralocorticoid Receptor Antagonists/pharmacology , Potassium/blood , Spironolactone/pharmacologyABSTRACT
Fulminant type 1 diabetes mellitus (FT1DM) develops as a result of very rapid and almost complete destruction of pancreatic ß cells. Because of an abrupt increase in plasma glucose, HbA1c and glycated albumin (GA) might increase along with duration of symptoms in FT1DM patients. We attempted to devise a formula to estimate duration of symptoms based on the increased levels in HbA1c or GA. Four patients who developed FT1DM during the course of type 2 diabetes mellitus and in whom HbA1c was measured before onset were investigated in this study. The percents of the estimated duration of symptoms calculated from HbA1c (four patients) and GA (two patients) to the actual duration were 137 ± 88% and 122%, respectively. In FT1DM patients in whom HbA1c and/or GA before onset and at the time of ketoacidosis are measured, duration of symptoms might be estimated with using the increased levels in HbA1c or GA.
ABSTRACT
A 48-year-old woman with transient thyrotoxicosis, having a slightly high thyroidal 99mTc uptake (3.9% at 20 m) or radioactive iodine uptake (RAIU) (17.3% at 4 hour) and subacute thyroiditis (SAT)-like symptoms, signs and histological diagnosis (extensive cellular destruction and granulomatous inflammatory change), showed positive TRAb (59.9%) and TSAb (194%) activity. The high levels of TRAb and slightly high RAIU were still observed after one month of prednisolone treatment. Nine months later, the TRAb and TSAb levels finally normalized and her thyroid function has remained normal since then. We suspect that the slightly high RAIU were due to the presence of both the TRAb and the TSAb and the course of this case might mimic neonatal Graves' disease.
