Zhang Xizi, Fu Yiyang, Shen Hang, Zeng Qinglian, Zhang Aipin, Du Zhipeng, Song Ying, Hu Jinbo, Ma Linqiang, Yang Yi, He Yifan, Zhen Qianna, Li Jiayu, Li Junlong, Zhang Qi, Li Qifu, Yang Shumin
Department of Endocrinology, Sichuan-Chongqing Joint Key Laboratory of Metabolic Vascular Diseases, Chongqing Key Laboratory of Translational Medicine in Major Metabolic Diseases, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Street, Chongqing, 400016, China.
Graduate Administration Office, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
J Endocrinol Invest. 2025 Aug 13. doi: 10.1007/s40618-025-02660-y.
Whether metanephrines (MNs)-corrected indices in adrenal venous sampling (AVS) would be useful in subtyping primary aldosteronism (PA) concurrent with autonomous cortisol secretion (ACS) remains unclear.
This retrospective study included PA patients concurrent with (PA/ACS) or without (isolated PA) ACS who underwent AVS. Firstly, optimal cut-offs for the metanephrine-based selectivity index (SI) and normetanephrine-based SI (SI) were determined using cortisol-corrected SI (SI≥2) as the reference in the isolated PA group. Subsequently, the accuracy of MNs-corrected indices was evaluated in the PA/ACS group.
130 isolated PA patients and 65 PA/ACS patients were included. In isolated PA, the optimal cut-off values of SI and SI were 3.4 and 1.6, respectively. Eleven PA/ACS patients had unsuccessful cannulation (SI<2), of whom, the diagnoses of 8 and 6 patients were rescued by SI and SI, respectively. Using lateralization index (LI) ≥ 4 to diagnose unilateral PA, 28 out of 65 PA/ACS were identified by cortisol- or NMN-corrected indices, and five more patients were identified by MN-corrected indices. Among 25 PA/ACS patients with a final subtyping diagnosis based on post-surgery outcomes, 52.0% (13/25) were correctly identified by both cortisol- and MNs-corrected indices. In the remaining 12 patients, four were correctly identified by MNs-corrected indices, one was correctly identified by cortisol-corrected indices alone, two were judged as unsuccessful cannulation by SI and all three indicators were wrongly subtyped in the five patients.
For patients with PA/ACS, MN-corrected AVS serves as a complementary approach to cortisol-corrected AVS.
肾上腺静脉采血（AVS）中经间甲肾上腺素（MNs）校正的指标是否有助于对合并自主性皮质醇分泌（ACS）的原发性醛固酮增多症（PA）进行亚型分类尚不清楚。
这项回顾性研究纳入了接受AVS的合并ACS（PA/ACS）或未合并ACS（孤立性PA）的PA患者。首先，在孤立性PA组中，以经皮质醇校正的选择性指数（SI≥2）为参考，确定基于间甲肾上腺素的选择性指数（SI）和基于去甲间甲肾上腺素的SI（SI）的最佳截断值。随后，在PA/ACS组中评估MNs校正指标的准确性。
纳入130例孤立性PA患者和65例PA/ACS患者。在孤立性PA中，SI和SI的最佳截断值分别为3.4和1.6。11例PA/ACS患者插管失败（SI<2），其中分别有8例和6例患者的诊断通过SI和SI得以挽救。使用侧化指数（LI）≥4诊断单侧PA，65例PA/ACS患者中有28例通过皮质醇或去甲间甲肾上腺素校正指标得以识别，另有5例患者通过MN校正指标得以识别。在25例根据术后结果最终进行亚型诊断的PA/ACS患者中，52.0%（13/25）通过皮质醇和MNs校正指标均被正确识别。在其余12例患者中，4例通过MNs校正指标被正确识别，1例仅通过皮质醇校正指标被正确识别，2例被SI判定为插管失败，5例患者的所有三项指标亚型分类均错误。
对于PA/ACS患者，MN校正的AVS可作为皮质醇校正AVS的补充方法。
