Rapid cortisol assay during adrenal vein sampling in patients with primary aldosteronism.
BACKGROUND
Adrenal vein sampling is considered the gold standard test to identify primary aldosteronism, the most frequent form of secondary hypertension. Technical difficulties with this procedure may be overcome by monitoring cortisol concentrations in the different sampling sites during catheterization.


METHODS
We applied a rapid automated cortisol assay performed on a benchtop immunoassay analyzer near the operating suite during the catheterization procedures in 5 hypertensive patients. A mean of 7.8 samples (range, 5-13) were collected from the vena cava as well as from right and left adrenal veins.


RESULTS
Cortisol concentrations measured by the rapid assay and by our routine method were comparable. Two of 5 patients were found to be affected by an aldosterone-producing adenoma and 3 of 5 by a bilateral adrenal hyperplasia. Cortisol determination during the adrenal vein sampling procedure allowed a successful cannulation in all patients, including a patient in whom it was necessary to cannulate 9 different candidate right adrenal veins before finding the correct one.


CONCLUSIONS
Intraoperative cortisol assays appeared safe, reproducible, simple to perform, rapid, and cost-effective. The approach represents a service-oriented model for the laboratory and can provide valuable and timely information for improving the success rate of adrenal vein catheterization.
Mengozzi
Giulio
G
Clinical Chemistry Laboratory and Divisions of Radiology, Internal Medicine and Hypertension, Surgery, University of Torino, Torino, Italy. gmengozzi@molinette.piemonte.it
Rossato
Denis
D
Bertello
Chiara
C
Garrone
Corrado
C
Milan
Alberto
A
Pagni
Roberto
R
Veglio
Franco
F
Mulatero
Paolo
P
D000236:Adenoma / Q000175:diagnosis; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis; D000311:Adrenal Glands / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000450:Aldosterone / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D006929:Hyperaldosteronism / Q000175:diagnosis*; D006965:Hyperplasia; D006973:Hypertension / Q000175:diagnosis; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D014680:Veins
D000450:Aldosterone; D006854:Hydrocortisone