Brief report: Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism

Richard J. Auchus, Donald W. Chandler, Sarita Singeetham, Neema Chokshi, Fiemu E. Nwariaku, Bart L. Dolmatch, Shelby A. Holt, Frank H. Wians, Shellie C. Josephs, Clayton K. Trimmer, Jorge Lopera, Wanpen Vongpatanasin, Shawna D. Nesbitt, David Leonard, Ronald G. Victor

Research output: Contribution to journalArticle

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Abstract

Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. Design, Setting, and Subjects: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. Main Outcome Measures: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. Results: The 18OHB/A ratios were much lower in blood draining APAs (2.17 ± 0.62) than in blood draining the contralateral adrenals (12.96 ± 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 ± 4.32; P ± 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 ± 11.51) compared with IHA adrenals (9.22 ± 5.18; P < 0.001) or the contralateral adrenals (6.23 ± 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. Conclusions: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.

Original languageEnglish (US)
Pages (from-to)2648-2651
Number of pages4
JournalJournal of Clinical Endocrinology and Metabolism
Volume92
Issue number7
DOIs
StatePublished - Jul 2007

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18-Hydroxycorticosterone
Hyperaldosteronism
Aldosterone
Veins
Blood
Sampling
Adenoma
Sampling Studies
Serum
Hydrocortisone
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

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Brief report : Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism. / Auchus, Richard J.; Chandler, Donald W.; Singeetham, Sarita; Chokshi, Neema; Nwariaku, Fiemu E.; Dolmatch, Bart L.; Holt, Shelby A.; Wians, Frank H.; Josephs, Shellie C.; Trimmer, Clayton K.; Lopera, Jorge; Vongpatanasin, Wanpen; Nesbitt, Shawna D.; Leonard, David; Victor, Ronald G.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 92, No. 7, 07.2007, p. 2648-2651.

Research output: Contribution to journalArticle

Auchus, Richard J. ; Chandler, Donald W. ; Singeetham, Sarita ; Chokshi, Neema ; Nwariaku, Fiemu E. ; Dolmatch, Bart L. ; Holt, Shelby A. ; Wians, Frank H. ; Josephs, Shellie C. ; Trimmer, Clayton K. ; Lopera, Jorge ; Vongpatanasin, Wanpen ; Nesbitt, Shawna D. ; Leonard, David ; Victor, Ronald G. / Brief report : Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism. In: Journal of Clinical Endocrinology and Metabolism. 2007 ; Vol. 92, No. 7. pp. 2648-2651.
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title = "Brief report: Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism",
abstract = "Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. Design, Setting, and Subjects: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. Main Outcome Measures: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. Results: The 18OHB/A ratios were much lower in blood draining APAs (2.17 ± 0.62) than in blood draining the contralateral adrenals (12.96 ± 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 ± 4.32; P ± 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 ± 11.51) compared with IHA adrenals (9.22 ± 5.18; P < 0.001) or the contralateral adrenals (6.23 ± 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. Conclusions: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.",
author = "Auchus, {Richard J.} and Chandler, {Donald W.} and Sarita Singeetham and Neema Chokshi and Nwariaku, {Fiemu E.} and Dolmatch, {Bart L.} and Holt, {Shelby A.} and Wians, {Frank H.} and Josephs, {Shellie C.} and Trimmer, {Clayton K.} and Jorge Lopera and Wanpen Vongpatanasin and Nesbitt, {Shawna D.} and David Leonard and Victor, {Ronald G.}",
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T1 - Brief report

T2 - Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism

AU - Auchus, Richard J.

AU - Chandler, Donald W.

AU - Singeetham, Sarita

AU - Chokshi, Neema

AU - Nwariaku, Fiemu E.

AU - Dolmatch, Bart L.

AU - Holt, Shelby A.

AU - Wians, Frank H.

AU - Josephs, Shellie C.

AU - Trimmer, Clayton K.

AU - Lopera, Jorge

AU - Vongpatanasin, Wanpen

AU - Nesbitt, Shawna D.

AU - Leonard, David

AU - Victor, Ronald G.

PY - 2007/7

Y1 - 2007/7

N2 - Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. Design, Setting, and Subjects: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. Main Outcome Measures: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. Results: The 18OHB/A ratios were much lower in blood draining APAs (2.17 ± 0.62) than in blood draining the contralateral adrenals (12.96 ± 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 ± 4.32; P ± 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 ± 11.51) compared with IHA adrenals (9.22 ± 5.18; P < 0.001) or the contralateral adrenals (6.23 ± 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. Conclusions: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.

AB - Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. Design, Setting, and Subjects: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. Main Outcome Measures: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. Results: The 18OHB/A ratios were much lower in blood draining APAs (2.17 ± 0.62) than in blood draining the contralateral adrenals (12.96 ± 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 ± 4.32; P ± 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 ± 11.51) compared with IHA adrenals (9.22 ± 5.18; P < 0.001) or the contralateral adrenals (6.23 ± 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. Conclusions: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.

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