Current clinical guidelines from the US Endocrine Society state that adrenal venous sampling (AVS) may not be necessary in patients younger than 35 years with marked aldosteronism and a solitary adrenal adenoma on imaging. At the time when the guidelines were published, only one study supported the statement, a study that included 6 patients younger than 35 years, all of whom had unilateral adenoma on imaging and unilateral primary aldosteronism (PA), according to AVS. Since then, to our knowledge, four additional studies have been published that provide data on concordance between conventional imaging and AVS among patients younger than 35 years. In these studies, 7 of 66 patients with unilateral disease on imaging had bilateral disease, according to AVS. We find it, therefore, reasonable to conclude that imaging studies alone inaccurately predict laterality in a significant number of young patients with PA and that available data challenge the current clinical guidelines.

美国内分泌学会当前的临床指南指出，对于 35 岁以下且影像学显示有明显醛固酮增多症和孤立性肾上腺腺瘤的患者，可能不需要进行肾上腺静脉采样 (AVS)。据 AVS 称，在指南发布时，只有一项研究支持这一说法，该研究纳入了 6 名年龄小于 35 岁的患者，所有患者均在影像学检查中患有单侧腺瘤和单侧原发性醛固酮增多症 (PA)。据我们所知，此后又发表了四项研究，提供了 35 岁以下患者的常规成像与 AVS 之间的一致性数据。根据 AVS 的数据，在这些研究中，66 名影像学上患有单侧疾病的患者中有 7 名患有双侧疾病。因此，我们发现有理由得出这样的结论：仅影像学研究无法准确预测大量年轻 PA 患者的偏侧性，并且现有数据对当前的临床指南提出了挑战。