Medizinische Klinik und Poliklinik IV, LMU Klinikum, Munich, Germany.
Endokrinologie in Charlottenburg, Berlin, Germany.
Eur J Endocrinol. 2022 Sep 29;187(5):637-650. doi: 10.1530/EJE-21-0541. Print 2022 Nov 1.
Cortisol measurements are essential for the interpretation of adrenal venous samplings (AVS) in primary aldosteronism (PA). Cortisol cosecretion may influence AVS indices. We aimed to investigate whether cortisol cosecretion affects non-adrenocorticotrophic hormone (ACTH)-stimulated AVS results.
Retrospective cohort study at a tertiary referral center.
We analyzed 278 PA patients who underwent non-ACTH-stimulated AVS and had undergone at least a 1-mg dexamethasone suppression test (DST). Subsets underwent additional late-night salivary cortisol (LSC) and/or 24-h urinary free cortisol (UFC) measurements. Patients were studied from 2013 to 2020 with follow-up data of 6 months following adrenalectomy or mineralocorticoid antagonist therapy initiation. We analyzed AVS parameters including adrenal vein aldosterone/cortisol ratios, selectivity, lateralization (LI) and contralateral suppression indices and post-operative ACTH-stimulation. We classified outcomes according to the primary aldosteronism surgical outcome (PASO) criteria.
Among the patients, 18.9% had a pathological DST result (1.9-5 µg/dL: n = 44 (15.8%); >5 µg/dL: n = 8 (2.9%)). Comparison of AVS results stratified according to the 1-mg DST (≤1.8 vs >1.8 µg/dL: P = 0.499; ≤1.8 vs 1.8 ≤ 5 vs >5 µg/dL: P = 0.811) showed no difference. Lateralized cases with post DST serum cortisol values > 5 µg/dL had lower LI (≤1.8 µg/dL: 11.11 (5.36; 26.76) vs 1.9-5 µg/dL: 11.76 (4.9; 31.88) vs >5 µg/dL: 2.58 (1.67; 3.3); P = 0.008). PASO outcome was not different according to cortisol cosecretion.
Marked cortisol cosecretion has the potential to influence non-ACTH-stimulated AVS results. While this could result in falsely classified lateralized cases as bilateral, further analysis of substitutes for cortisol are required to unmask effects on clinical outcome.
皮质醇测量对于原发性醛固酮增多症（PA）的肾上腺静脉采样（AVS）解释至关重要。皮质醇共分泌可能会影响 AVS 指数。我们旨在研究皮质醇共分泌是否会影响非促肾上腺皮质激素（ACTH）刺激的 AVS 结果。
在一家三级转诊中心进行的回顾性队列研究。
我们分析了 278 例接受非 ACTH 刺激 AVS 且至少进行过 1mg 地塞米松抑制试验（DST）的 PA 患者。部分患者进行了额外的夜间唾液皮质醇（LSC）和/或 24 小时尿游离皮质醇（UFC）测量。患者于 2013 年至 2020 年进行研究，术后随访 6 个月，包括肾上腺切除术或盐皮质激素受体拮抗剂治疗开始后。我们分析了 AVS 参数，包括肾上腺静脉醛固酮/皮质醇比值、选择性、侧化（LI）和对侧抑制指数以及术后 ACTH 刺激。我们根据原发性醛固酮增多症手术结果（PASO）标准对结果进行分类。
在这些患者中，18.9%的患者 DST 结果异常（1.9-5μg/dL：n=44（15.8%）；>5μg/dL：n=8（2.9%））。根据 1mg DST 进行 AVS 结果分层比较（≤1.8μg/dL：P=0.499；≤1.8μg/dL 与 1.8μg/dL≤5μg/dL 与>5μg/dL：P=0.811），无差异。DST 后血清皮质醇值>5μg/dL 的侧化病例 LI 较低（≤1.8μg/dL：11.11（5.36；26.76）vs 1.9-5μg/dL：11.76（4.9；31.88）vs>5μg/dL：2.58（1.67；3.3）；P=0.008）。根据皮质醇共分泌，PASO 结果无差异。
明显的皮质醇共分泌有可能影响非 ACTH 刺激的 AVS 结果。虽然这可能导致错误地将侧化病例归类为双侧，但需要进一步分析皮质醇替代物以揭示其对临床结果的影响。
