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


OBJECTIVE
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.


METHODS
We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals.


METHODS
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.
Auchus
Richard J
RJ
Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8857, USA. richard.auchus@UTSouthwestern.edu
Chandler
Donald W
DW
Singeetham
Sarita
S
Chokshi
Neema
N
Nwariaku
Fiemu E
FE
Dolmatch
Bart L
BL
Holt
Shelby A
SA
Wians
Frank H
FH
Josephs
Shellie C
SC
Trimmer
Clayton K
CK
Lopera
Jorge
J
Vongpatanasin
Wanpen
W
Nesbitt
Shawna D
SD
Leonard
David
D
Victor
Ronald G
RG
D015069:18-Hydroxycorticosterone / Q000097:blood*; D000311:Adrenal Glands / Q000098:blood supply* / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis*; D010865:Pilot Projects; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014680:Veins
D015415:Biomarkers; D015069:18-Hydroxycorticosterone; D006854:Hydrocortisone