Mosso L, Gómez-Sánchez C E, Foecking M F, Fardella C
Department of Endocrinology Faculty of Medicine Pontificia Universidad Católica de Chile, Santiago, Chile.
Hypertension. 2001 Sep;38(3 Pt 2):688-91. doi: 10.1161/01.hyp.38.3.688.
This study reports the determination of plasma 18-hydroxycortisol (18-OHF) using a new and easy enzyme-linked immunosorbent assay (ELISA) method in primary aldosteronism and compares the values found in essential hypertensives and normotensive controls. In primary aldosteronism, we evaluated usefulness of plasma 18-OHF determination and the dexamethasone suppression test in the diagnosis of glucocorticoid-remediable aldosteronism using the genetic test as the gold standard. We studied 31 primary aldosteronism patients, 101 essential hypertensives, and 102 healthy normotensive controls. The plasma 18-OHF was measured using a biotin-avidin enzyme-linked assay by a new and purified polyclonal antibody. The 18-OHF value in primary aldosteronism was 6.3+/-8.05 nmol/L; this value is significantly higher than the value found in essential hypertensives and normotensive controls (2.81+/-1.42 and 2.70+/-1.41 nmol/L, respectively; P<0.0005). In primary aldosteronism, 4 of 31 patients had 18-OHF levels that were 10 times higher than the normal upper limit (2.983 nmol/L). The dexamethasone suppression test in primary aldosteronism patients was positive (serum aldosterone <4 ng/dL) in 13 of 31 cases. A chimeric CYP11B1/CYP11B2 gene was demonstrated in 4 primary aldosteronism patients, corresponding to the same cases that had higher level of 18-OHF. In conclusion, plasma 18-OHF determination by this ELISA method is reliable for detecting glucocorticoid-remediable aldosteronism, and it does so better than the dexamethasone suppression test.
本研究报告了一种新型简易酶联免疫吸附测定（ELISA）法测定原发性醛固酮增多症患者血浆18-羟皮质醇（18-OHF）的情况，并比较了原发性高血压患者和血压正常对照组的检测值。在原发性醛固酮增多症中，我们以基因检测作为金标准，评估了血浆18-OHF测定及地塞米松抑制试验在糖皮质激素可治性醛固酮增多症诊断中的作用。我们研究了31例原发性醛固酮增多症患者、101例原发性高血压患者和102例血压正常的健康对照者。采用生物素-抗生物素蛋白酶联测定法，使用新的纯化多克隆抗体测定血浆18-OHF。原发性醛固酮增多症患者的18-OHF值为6.3±8.05 nmol/L；该值显著高于原发性高血压患者和血压正常对照组（分别为2.81±1.42和2.70±1.41 nmol/L；P<0.0005）。在原发性醛固酮增多症患者中，31例中有4例的18-OHF水平高于正常上限（2.983 nmol/L）的10倍。31例原发性醛固酮增多症患者中，有13例的地塞米松抑制试验呈阳性（血清醛固酮<4 ng/dL）。4例原发性醛固酮增多症患者检测到嵌合型CYP11B1/CYP11B2基因，与18-OHF水平较高的病例相同。总之，采用这种ELISA法测定血浆18-OHF对于检测糖皮质激素可治性醛固酮增多症是可靠的，且比地塞米松抑制试验效果更好。
