Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy.
Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
J Clin Endocrinol Metab. 2023 Aug 18;108(9):e720-e725. doi: 10.1210/clinem/dgad179.
Adrenal venous sampling (AVS) is the gold standard procedure for subtype diagnosis in patients with primary aldosteronism (PA). Cortisol is usually adopted for the normalization of aldosterone levels in peripheral and adrenal samples. However, asymmetrical cortisol secretion can potentially affect the lateralization index, leading to subtype misdiagnosis.
We aimed to assess the prevalence of asymmetrical cortisol secretion in patients undergoing AVS and whether variations in adrenal vein cortisol might influence AVS interpretations. We then evaluated the use of metanephrines for the normalization of aldosterone levels for lateralization index.
We retrospectively included 101 patients with PA who underwent AVS: 49 patients underwent unstimulated AVS, while 52 patients underwent both unstimulated and cosyntropin-stimulated AVS. Eighty-eight patients had bilateral successful AVS according to metanephrine ratio. We assessed the prevalence of asymmetrical cortisol secretion through the cortisol to metanephrine (C/M) lateralization index (LI). We then evaluated whether the use of aldosterone to metanephrine (A/M) LI can improve the diagnostic accuracy of AVS compared with aldosterone to cortisol (A/C) LI.
Asymmetrical cortisol secretion is present in 18% of patients with PA. Diagnosis with A/M LI and A/C LI is discordant in 14% of patients: 9% had a diagnosis of unilateral PA with A/M LI instead of bilateral PA with A/C LI and 5% had a diagnosis of bilateral PA with A/M LI instead of unilateral PA.
The assessment of metanephrine levels in AVS is useful for the determination of selectivity and lateralization, allowing an accurate diagnosis, especially in patients with asymmetrical cortisol secretion.
肾上腺静脉采样（AVS）是原发性醛固酮增多症（PA）亚型诊断的金标准。皮质醇通常用于外周和肾上腺样本中醛固酮水平的标准化。然而，皮质醇分泌的不对称性可能会影响侧化指数，导致亚型误诊。
我们旨在评估接受 AVS 的患者中皮质醇分泌不对称的患病率，以及肾上腺静脉皮质醇的变化是否会影响 AVS 解读。然后，我们评估使用间甲肾上腺素对醛固酮水平进行标准化以用于侧化指数。
我们回顾性纳入了 101 例接受 AVS 的 PA 患者：49 例患者接受了未刺激的 AVS，而 52 例患者接受了未刺激和促皮质素刺激的 AVS。根据间甲肾上腺素比值，88 例患者双侧 AVS 均成功。我们通过皮质醇与间甲肾上腺素（C/M）侧化指数（LI）评估皮质醇分泌不对称的患病率。然后，我们评估了与醛固酮与皮质醇（A/C）LI 相比，使用醛固酮与间甲肾上腺素（A/M）LI 是否可以提高 AVS 的诊断准确性。
PA 患者中存在 18%的皮质醇分泌不对称。使用 A/M LI 和 A/C LI 进行诊断存在不一致性，在 14%的患者中：9%的患者被诊断为单侧 PA，而 A/C LI 为双侧 PA，5%的患者被诊断为双侧 PA，而 A/M LI 为单侧 PA。
在 AVS 中评估间甲肾上腺素水平有助于确定选择性和侧化性，从而可以进行准确的诊断，尤其是在存在皮质醇分泌不对称的患者中。
