BRIEF REPORT Measurement of 18Hydroxycorticosterone during Adrenal Vein Sampling for Primary Aldosteronism (original) (raw)
Related papers
European Journal of Endocrinology, 2010
Objective: In primary aldosteronism, adrenal venous sampling (AVS) is essential for subtype differentiation as it evaluates aldosterone secretion from both adrenals. Selectivity of adrenal sampling is assessed by the ratio of cortisol concentrations in adrenal venous blood and inferior vena cava blood (C adrenal /C ivc ). Since the criteria for selective adrenal sampling differ among the reported literature, we performed a study to evaluate the influence of different selectivity criteria on AVS results. Design and methods: Reports of AVS were screened retrospectively. All AVS were performed with cosyntrophin infusion. Reports containing samples with C adrenal /C ivc R10 taken from both adrenals and at least one other adrenal sample characterised by C adrenal /C ivc R1.1 were enrolled. For each individual, we chose reference samples that were defined by the highest C adrenal /C ivc achieved from each adrenal. The significance of the remaining samples with C adrenal /C ivc R1.1 was analysed in regard to their respective reference samples. We assessed the impact of analysed samples on identification of lateralisation of aldosterone secretion that is crucial for decisions concerning adrenalectomy. Results: AVS reports of 87 patients were enrolled. A total of 225 adrenal samples were analysed and divided into five groups according to C adrenal /C ivc :1.1-1.99, 2-2.99, 3-4.99, 5-9.99 and R10. By comparing reference with analysed samples, a concordant assessment with respect to lateralisation of aldosterone secretion was observed in 39, 52, 72, 85 and 94% of the respective groups of analysed samples.
Context: Adrenal vein sampling (AVS) is required to identify a lateralized or bilateral aldosterone source in primary aldosteronism. Objectives: Our objectives were to compare basal and post-ACTH selectivity ratio (SR) and later-alization ratio (LR) and to determine the prevalence of basal contralateral suppression and its effect on surgical outcome. Patients and Intervention: Bilateral simultaneous adrenal vein samples were obtained before and after a 250-g bolus of ACTH. Analyses were conducted on 171 technically successful AVS and on the subgroup of 66 operated patients with evaluable outcome data. Results: ACTH increased selectivity on both sides from 66.7% in basal samples (SR 2) to 91.8% poststimulation (SR 5). A discordance of lateralization between basal (LR 2) and post-ACTH (LR 4) values was observed in 28% of cases, which were mostly lateralized cases basally that became bilateral post-ACTH. Basal CL suppression is present in only 30% using absolute ratio of aldosterone between the opposite (nondominant) adrenal vein and the peripheral vein A OPP /A P below 1.5 vs in 77% using aldosterone/cortisol ratio (A/C) OPP /(A/C) P below 1.5. The absence of CL suppression was associated with a lower rate of response to adrenalectomy in terms of clinical and biochemical parameters with difference in clinical cure (55% vs 13% P .0003) and overall cure (35% vs 9%, P .0084) using A OPP /A P , but not when using (A/C) OPP /(A/C) P. Conclusions: Stimulation with ACTH is useful to improve selectivity of AVS but can frequently modify interpretation of lateralization. Basal ratios are as important as post-ACTH ratios to set an indication of adrenalectomy. A OPP /A P is superior to (A/C) OPP /(A/C) P to assess contralateral suppression. Infrequent CL suppression reveals frequent occurrence of contralateral hyperplasia in lateralized cases and helps predict postoperative outcomes. (J Clin Endocrinol Metab 101: 1826 –1835, 2016)
2015
Objective: Many investigators believe basal adrenal venous sampling (AVS) should be done simultaneously while others opt for sequential AVS for simplicity and reduced cost. This study aimed to evaluate concordance of sequential and simultaneous AVS methods. Design and methods: Between 1989 and 2015, bilateral simultaneous sets of basal AVS were obtained twice within 5 minutes, in 188 consecutive patients (59 women and 129 men; mean age 53.4 years). Selectivity was defined by adrenal to peripheral cortisol ratio ≥2 and lateralization was defined as an adrenal aldosterone to cortisol ratio > 2 the contralateral side. Sequential AVS were simulated by using right sampling at-5 minutes (t=-5) and left sampling at 0 minute (t=0). Results: There was no significant difference in mean selectivity ratio (p=0.12 and p=0.42 for the right and left sides respectively) and in mean lateralization ratio (p=0.93) between t=-5 and t=0. Kappa for selectivity between 2 simultaneous AVS was 0.71 (
Endokrynologia Polska
Introduction: Failure of adrenal vein sampling (AVS) due to difficult cannulation of the right adrenal vein (AV) frequently precludes subtyping of patients with primary aldosteronism (PA) before adrenalectomy. According to a recent study, lateralized PA could be accurately predicted from partial AVS data based on the gradient of the aldosterone-to-cortisol ratios (ACR) between left AV and inferior vena cava (IVC) (LAV/IVC index). We aimed to validate the diagnostic utility of this index for PA subtyping in our cohort. Material and methods: A retrospective cross-sectional study included all patients who underwent bilaterally successful AVS at our centre and were diagnosed with either bilateral PA according to AVS or with lateralized PA after successful adrenalectomy from November 2004 to the end of 2019. Final diagnoses were compared to originally suggested LAV/IVC index cutoffs of ≥ 5.5 for ipsilateral disease and of ≤ 0.5 for contralateral disease, respectively. Results: The inclusion criteria were met in 168 patients: 46 women and 122 men, aged 54 years on average (range 32-72 years); 67 with lateralized and 101 with bilateral PA. LAV/IVC index using cutoffs of ≥ 5.5 or ≤ 0.5 anticipated ipsilateral (left lateralized) PA with a sensitivity of 32% and specificity of 97%, while a sensitivity of 47% and specificity of 95%, were found for contralateral (right lateralized) PA in our cohort. The overall inappropriate adrenalectomy rate was 29.7% (p = 0.314 for comparison between sides). When ascertaining ipsilateral disease (LAV/IVC index ≥ 5.5), 4 out of 16 patients (25%) would have been incorrectly sent to left adrenalectomy. Inappropriate right adrenalectomy would have occurred in 7 out of 21 patients (33.3%) when predicting contralateral disease (LAV/IVC index of ≤ 0.5). Thus, 11 patients with bilateral PA (6.5% of the entire cohort) would have been misclassified as lateralized PA and referred to surgery. Failed lateralization would have occurred in 61.2% of patients overall (53.3% for overlooked contralateral disease, 67.6% for missed ipsilateral disease; p = 0.723 for comparison between sides). Conclusions: Based on our cohort, we conclude that application of the suggested LAV/IVC index cutoffs did not predict lateralized PA with the high accuracy previously reported.
Adrenal venous sampling in primary aldosteronism
Journal of Hypertension, 2017
Difficulty to recognize or canulate the right adrenal vein is the most frequent cause of adrenal venous sampling (AVS) failure. We aimed to assess multinomial regression modeling (MRM) of peripheral and left adrenal vein samplings to detect lateralization of aldosterone secretion when the right AVS is missing. Methods: Simultaneous bilateral AVS samplings were performed before (basal) and after intravenous cosyntropin injection in 188 consecutive patients between December 1989 and September 2015. Different reference standards for lateralization of aldosterone secretion were defined for basal and for postcosyntropin AVS and according to lateralization index cutoffs at least 2 and at least 4. MRMs were built to detect lateralization of aldosterone secretion according to these reference standards using only peripheral and left adrenal veins samplings (without the right AVS). Detection accuracy was assessed by the area under the receiver operating characteristic (AUROC) curves and detection sensitivities were reported for specificity at least 95%. Results: For basal AVS with lateralization index at least 2, AUROC were respectively 0.931 [95% confidence interval (CI) 0.894-0.968] and 0.922 (95% CI 0.882-0.962) for right and left lateralization of aldosterone secretion detection and MRM could detect respectively 65.5 and 62.7% of the right and left lateralization of aldosterone secretion. For AVS after cosyntropin with lateralization index at least 4, AUROC were respectively 0.964 (95% CI: 0.940-0.987) and 0.955 (95% CI: 0.927-0.983) for right and left lateralization of aldosterone secretion, and MRM could detect respectively 77.2 and 72.9% of the right and left lateralization of aldosterone secretion. Conclusion: MRM can detect lateralization of aldosterone secretion without the right AVS in most patients and could eliminate the need for repeat AVS when right adrenal vein canulation is nonselective or impossible.
American Journal of Hypertension, 2021
Background Normal-appearing adrenal glands on cross-sectional imaging may still be the source of aldosterone production in primary aldosteronism (PA). Methods We evaluated the prevalence of aldosterone production among morphologically normal-appearing adrenal glands and the impact of this phenomenon on interpretations of localization studies and treatment decisions. We performed a retrospective cohort study of PA patients with at least 1 normal adrenal gland and reanalyzed contemporary studies to assess interpretations of imaging and adrenal venous sampling (AVS) at the individual patient and adrenal levels. Results Among 243 patients, 43 (18%) had bilateral normal-appearing adrenals and 200 (82%) had a unilateral normal-appearing adrenal, for a total of 286 normal-appearing adrenal glands. 38% of these normal-appearing adrenal glands were a source of aldosteronism on AVS, resulting in discordance between imaging and AVS findings in 31% of patients. Most patients with lateralizing P...
Hypertension, 2009
Adrenocorticotropic hormone administration was proposed to overcome the biases associated with pulsatile aldosterone secretion during adrenal venous sampling, but the usefulness of different protocols of stimulation was never systematically assessed. We, therefore, compared the effects of a high dose (HD; 250 μg IV as a bolus), a very low dose (VLD; 250 pg IV), and an intermediate dose (ID; 50 μg/h) of adrenocorticotropic hormone on the selectivity index (SI) and the lateralization index in primary aldosteronism patients, using the diagnosis of aldosterone-producing adenoma, based on pathology and follow-up data, as a reference. The HD (n=47) significantly increased plasma cortisol concentration in infrarenal inferior vena cava (+79%) blood and the SI on both sides (SI RIGHT +113% and SI LEFT +131%), as compared with baseline values. The ID (n=14) also markedly increased both plasma cortisol concentration inferior vena cava (+93%) and the SI (SI RIGHT +690% and SI LEFT +410%); the v...