TY - JOUR
T1 - Brief report
T2 - Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism
AU - Auchus, Richard J.
AU - Chandler, Donald W.
AU - Singeetham, Sarita
AU - Chokshi, Neema
AU - Nwariaku, Fiemu E.
AU - Dolmatch, Bart L.
AU - Holt, Shelby A.
AU - Wians, Frank H.
AU - Josephs, Shellie C.
AU - Trimmer, Clayton K.
AU - Lopera, Jorge
AU - Vongpatanasin, Wanpen
AU - Nesbitt, Shawna D.
AU - Leonard, David
AU - Victor, Ronald G.
N1 - Funding Information:
This work was supported by a Clinical Scientist Award in Translational Research from the Burroughs Wellcome Fund (Grant 1005954 to R.J.A.), a Harold Amos Faculty Development Award from the Robert Wood Johnson Foundation (to F.E.N.), and a Clinical and Basic Research Training Grant for Medical Students T35-DK066141 (Michael J. McPhaul, Principal Investigator) supporting N.C. and S.S.
PY - 2007/7
Y1 - 2007/7
N2 - Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. Design, Setting, and Subjects: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. Main Outcome Measures: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. Results: The 18OHB/A ratios were much lower in blood draining APAs (2.17 ± 0.62) than in blood draining the contralateral adrenals (12.96 ± 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 ± 4.32; P ± 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 ± 11.51) compared with IHA adrenals (9.22 ± 5.18; P < 0.001) or the contralateral adrenals (6.23 ± 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. Conclusions: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.
AB - Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. Design, Setting, and Subjects: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. Main Outcome Measures: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. Results: The 18OHB/A ratios were much lower in blood draining APAs (2.17 ± 0.62) than in blood draining the contralateral adrenals (12.96 ± 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 ± 4.32; P ± 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 ± 11.51) compared with IHA adrenals (9.22 ± 5.18; P < 0.001) or the contralateral adrenals (6.23 ± 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. Conclusions: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.
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U2 - 10.1210/jc.2006-2631
DO - 10.1210/jc.2006-2631
M3 - Article
C2 - 17473070
AN - SCOPUS:34447130276
SN - 0021-972X
VL - 92
SP - 2648
EP - 2651
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 7
ER -