Htut Zin, Alsafi Ali, Sharma Aditi, Foran Daniel, Tan Tricia, Barnes Sophie C, Williams Emma L, Papadopoulou Debbie, Dimarco Aimee, Palazzo Fausto, Todd Jeannie, Fikri Rami, Wass John, Meeran Karim, Wernig Florian
Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Clin Endocrinol (Oxf). 2025 Sep;103(3):294-302. doi: 10.1111/cen.15277. Epub 2025 May 19.
Primary aldosteronism (PA) is a prevalent yet frequently underdiagnosed cause of secondary hypertension, affecting up to 10% of hypertensive individuals and contributing to increased cardiovascular risk. Accurate diagnosis is vital, as unilateral PA cases typically require surgical intervention, while bilateral disease is managed medically. Adrenal vein sampling (AVS) remains the gold standard for diagnosing subtypes of PA; however, the use of cortisol to confirm accuracy of cannulation poses challenges due to its long half-life and potential cortisol co-secretion by aldosterone-producing adenomas.
This study evaluates the diagnostic utility of plasma metanephrines (MN) as an alternative to cortisol in assessing cannulation success and lateralisation of aldosterone secretion.
Analysing 132 unstimulated AVS procedures performed by a single operator on 129 patients with confirmed PA, we established optimal cut-off values for the selectivity index (SI) and lateralisation index (LI) using MN.
A MN SI cut-off of >3 achieved 99% sensitivity and 100% specificity, while an aldosterone/MN LI of >4 indicated unilateral disease with 94% sensitivity and 96% specificity.
Our findings demonstrate that incorporating MN measurements significantly enhances the accuracy of AVS interpretations, particularly in cases of cortisol co-secretion, thereby minimising diagnostic errors and optimising treatment strategies. This study supports the use of MN as reliable analytes to improve the diagnostic accuracy of AVS.
原发性醛固酮增多症（PA）是继发性高血压的常见病因，但常被漏诊，影响高达10%的高血压患者，并增加心血管疾病风险。准确诊断至关重要，因为单侧PA病例通常需要手术干预，而双侧疾病则采用药物治疗。肾上腺静脉采血（AVS）仍然是诊断PA亚型的金标准；然而，由于皮质醇半衰期长以及醛固酮瘤可能同时分泌皮质醇，使用皮质醇来确认插管准确性存在挑战。
本研究评估血浆甲氧基肾上腺素（MN）作为皮质醇替代物在评估插管成功率和醛固酮分泌侧别方面的诊断效用。
分析由一名操作者对129例确诊PA患者进行的132例非刺激状态下的AVS操作，我们使用MN确定了选择性指数（SI）和侧别指数（LI）的最佳截断值。
MN SI截断值>3时，灵敏度达99%，特异性达100%；而醛固酮/MN LI>4表明为单侧疾病，灵敏度为94%，特异性为96%。
我们的研究结果表明，纳入MN测量可显著提高AVS解读的准确性，尤其是在皮质醇共分泌的情况下，从而最大限度地减少诊断错误并优化治疗策略。本研究支持将MN用作可靠的分析物以提高AVS的诊断准确性。
