Plasma metanephrine for assessing the selectivity of adrenal venous sampling

Dekkers, Tanja; Deinum, J.; Schultzekool, LJ; Bondin, Daniela; Peitzsch, Mirko; Antoch, Gerald; Rump, L. C.; Willenberg, HS; Lenders, JW; Eisenhofer, Graeme

doi:10.1055/s-0033-1336616

Cited by 7 publications

(11 citation statements)

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“…We previously established that cortisol is inferior to metanephrine for determining selectivity of adrenal venous catheterization (13 ). In a subsequent study, we also established DHEA and androstenedione as further alternatives to cortisol for determining selectivity of AVS (23 ).…”

Section: Discussionmentioning

confidence: 99%

“…Inclusion also required demonstration of bilateral selectivity of AVS, confirmed according to ratios of metanephrine or adrenal steroids in adrenal to peripheral venous plasma (13,23 ). Follow-up of patients with APAs was also required to verify the diagnosis.…”

Section: Patientsmentioning

confidence: 99%

“…Continuous cosyntropin stimulation (50 g/h) was used during AVS procedures at Nijmegen, whereas procedures at the 2 other centers were performed without cosyntropin. We collected blood samples (2-8 mL) from both adrenal veins by gravity or gentle negative pressure, with additional collections (8 mL) of peripheral venous blood for assessing selectivity of AVS and contralateral suppression of aldosterone secretion as described (10,13,23 ). Samples were collected into tubes containing lithium heparin (Nijmegen and Düsseldorf) or EDTA (Munich) as anticoagulants, transported on ice to laboratories within 15 min of collection, and centrifuged at 3000 -3500g (4°C) for 10 -15 min.…”

Section: Patientsmentioning

confidence: 99%

“…Cortisol was measured with an automated chemiluminescence assay (Liaison, Diasorin) at Munich, whereas electrochemiluminescence immunoassays at Nijmegen and Düsseldorf used the Modular E170 and Elecsys (Roche Diagnostics) analyzers, respectively. Performance characteristics of these assays are detailed elsewhere (13,23,28 ).…”

Section: Subtype Diagnosesmentioning

confidence: 99%

“…Concomitant autonomous adrenal cortisol overproduction can obscure the presence of unilateral aldosterone excess (11,12 ). Because cortisol has a long plasma half-life, relative differences in peripheral to adrenal venous concentrations do not always accurately indicate selectivity of AVS (13 ). There are also well-known inaccuracies in immunoassay methods (14 -22 ) that may particularly impact adrenal venous measurements of adrenal steroids, such as aldosterone, where immuno-crossreactivity with high concentrations of other steroids could compromise results.…”

mentioning

confidence: 99%

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Mass Spectrometry–Based Adrenal and Peripheral Venous Steroid Profiling for Subtyping Primary Aldosteronism

Eisenhofer

Dekkers

Peitzsch³

et al. 2016

Clinical Chemistry

130

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BACKGROUND:Differentiating patients with primary aldosteronism caused by aldosterone-producing adenomas (APAs) from those with bilateral adrenal hyperplasia (BAH), which is essential for choice of therapeutic intervention, relies on adrenal venous sampling (AVS)-based measurements of aldosterone and cortisol. We assessed the utility of LC-MS/MS-based steroid profiling to stratify patients with primary aldosteronism.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Subtype Diagnosesmentioning

confidence: 99%

mentioning

confidence: 99%

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Mass Spectrometry–Based Adrenal and Peripheral Venous Steroid Profiling for Subtyping Primary Aldosteronism

Eisenhofer

Dekkers

Peitzsch³

et al. 2016

Clinical Chemistry

130

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Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

Yang

Reincke

Williams

2020

Best Practice & Research Clinical Endocrinology & Metab

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Primary aldosteronism (PA) is the most common potentially curable form of hypertension. The overproduction of aldosterone leads to an increased risk of cardiovascular and cerebrovascular events as well as adverse effects to the heart and kidney and psychological disorders. PA is mainly caused by unilateral aldosterone excess due to an aldosterone-producing adenoma or bilateral excess due to bilateral adrenocortical hyperplasia. The diagnostic work-up of PA comprises three steps: screening, confirmatory testing and differentiation of unilateral surgically-correctable forms from medically treated bilateral PA. These specific treatments can mitigate or reverse the increased risks associated with PA. Herein we summarise the prevalence, outcomes and current and future clinical approaches for the diagnosis of primary aldosteronism.

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Role of Adrenal Vein Sampling in Guiding Surgical Decision in Primary Aldosteronism

Younes,

Larose,

Bourdeau

et al. 2023

Exp Clin Endocrinol Diabetes

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Adrenal vein sampling (AVS) is recommended for subtyping primary aldosteronism (PA) to identify lateralized or bilateral sources of aldosterone excess, allowing for better decision-making in regard to medical or surgical management on a case-by-case basis. To date, no consensus exists on protocols to be used during AVS, especially concerning sampling techniques, the timing of sampling, and whether or not to use adrenocorticotropic hormone (ACTH) stimulation. Interpretation criteria for selectivity, lateralization, and contralateral suppression vary from one expert center to another, with some favoring strict cut-offs to others being more permissive. Clinical and biochemical post-operative outcomes can also be influenced by AVS criteria utilized to indicate surgical therapy.In this review, we reanalyze studies on AVS highlighting the recent pathological findings of frequent micronodular hyperplasia adjacent to a dominant aldosteronoma (APA) overlapping with bilateral idiopathic hyperaldosteronism (IHA) etiologies, as opposed to the less frequent unilateral single aldosteronoma. The variable expression of melanocortin type 2 receptors in the nodules and hyperplasia may explain the frequent discordance in lateralization ratios between unstimulated and ACTH- stimulated samples. We conclude that aldosterone values collected during simultaneous bilateral sampling, both at baseline and post-ACTH stimulation, are required to adequately evaluate selectivity, lateralization, and contralateral suppression during AVS, to better identify all patients with PA that can benefit from a surgical indication. Recommended cut-offs for each ratio are also presented.

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Plasma metanephrine for assessing the selectivity of adrenal venous sampling

Cited by 7 publications

References 0 publications

Mass Spectrometry–Based Adrenal and Peripheral Venous Steroid Profiling for Subtyping Primary Aldosteronism

Mass Spectrometry–Based Adrenal and Peripheral Venous Steroid Profiling for Subtyping Primary Aldosteronism

Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

Role of Adrenal Vein Sampling in Guiding Surgical Decision in Primary Aldosteronism

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