Adrenal androgens versus cortisol for primary aldosteronism subtype determination in adrenal venous sampling.
CYP11B2
adrenal androgens
adrenal venous sampling
aldosterone producing adenoma
bilateral adrenal hyperplasia
primary aldosteronism
subtype classification of primary aldosteronism
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
revised:
14
12
2021
received:
28
09
2021
accepted:
19
12
2021
pubmed:
16
2
2022
medline:
4
8
2022
entrez:
15
2
2022
Statut:
ppublish
Résumé
We examined if measurement of adrenal androgens adds to subtype diagnostics of primary aldosteronism (PA) under cosyntropin-stimulated adrenal venous sampling (AVS). A prospective pre-specified secondary endpoint analysis of 49 patients with confirmed PA, of whom 29 underwent unilateral adrenalectomy with long-term follow-up. Concentrations of androstenedione, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEAS) were measured during AVS in addition to aldosterone and cortisol. Subjects with lateralisation index (LI) of ≥4 were treated with unilateral adrenalectomy, and the immunohistochemical subtype was determined with CYP11B2 and CYP11B1 stains. The performance of adrenal androgens was evaluated by receiver operating characteristics (ROC) curve analyses in adrenalectomy and medical therapy groups. During AVS, the correlations between cortisol and androstenedione, DHEA and DHEAS for LI and selectivity index (SI) were highly significant. The right and left side SIs for androstenedione and DHEA were higher (p < .001) than for cortisol. In ROC analysis, the optimal LI cut-off values for androstenedione, DHEA and DHEAS were 4.2, 4.5 and 4.6, respectively. The performance of these LIs for adrenal androgens did not differ from that of cortisol. Under cosyntropin-stimulated AVS, the measurement of androstenedione and DHEA did not improve the cannulation selectivity. The performance of cortisol and adrenal androgens are confirmatory but not superior to cortisol-based results in lateralisation diagnostics of PA.
Identifiants
pubmed: 35167715
doi: 10.1111/cen.14691
pmc: PMC9544970
doi:
Substances chimiques
Androgens
0
Cosyntropin
16960-16-0
Androstenedione
409J2J96VR
Dehydroepiandrosterone
459AG36T1B
Aldosterone
4964P6T9RB
Hydrocortisone
WI4X0X7BPJ
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
241-249Informations de copyright
© 2022 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.
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