Comparison of Cortisol, Androstenedione and Metanephrines to Assess Selectivity and Lateralization of Adrenal Vein Sampling in Primary Aldosteronism

被引:21
作者
Ceolotto, Giulio [1 ]
Antonelli, Giorgia [2 ]
Caroccia, Brasilina [1 ]
Battistel, Michele [3 ]
Barbiero, Giulio [3 ]
Plebani, Mario [2 ]
Rossi, Gian Paolo [1 ]
机构
[1] Univ Padua, Specialized Ctr Blood Pressure Disorders Reg Vene, Dept Med DIMED, I-35126 Padua, Italy
[2] Univ Padua, Dept Med DIMED, Lab Med, I-35126 Padua, Italy
[3] Univ Padua, Inst Radiol, Dept Med DIMED, I-35126 Padua, Italy
关键词
adrenal vein sampling; cortisol; androstenedione; metanephrines; primary aldosteronism; DIAGNOSIS; ASSAY;
D O I
10.3390/jcm10204755
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Success of adrenal vein sampling (AVS) is verified by the selectivity index (SI), i.e., by a step-up of cortisol levels between the adrenal vein and the infrarenal inferior vena cava samples, beyond a given cut-off. We tested the hypothesis that androstenedione, metanephrine, and normetanephrine, which have higher gradients than cortisol, could increase the rate of AVS studies judged to be bilaterally successful and usable for the clinical decision making. We prospectively compared within-patient, head-to-head, the selectivity index of androstenedione (SIA), metanephrine (SIM), and normetanephrine (SINM), and cortisol (SIC) in consecutive hypertensive patients with primary aldosteronism submitted to AVS. Main outcome measures were rate of bilateral success, SI values, and identification of unilateral PA. We recruited 136 patients (55 + 10 years, 35% women). Compared to the SIC, the SIA values were 3.5-fold higher bilaterally, and the SIM values were 7-fold and 4.4-fold higher on the right and the left side, respectively. With the SIA and the SIM the rate of bilaterally successful AVS increased by 14% and 15%, respectively without impairing the identification of unilateral PA. We concluded that androstenedione and metanephrine outperformed cortisol for ascertaining AVS success, thus increasing the AVS studies useable for the clinical decision making.
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页数:13
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