title: 18-hydroxycorticosterone, 18-hydroxycortisol, and 18-oxocortisol in the diagnosis of primary aldosteronism and its subtypes.
abstract: BACKGROUND
  Diagnosis of primary aldosteronism (PA) is made by screening, confirmation testing, and subtype diagnosis (computed tomography scan and adrenal vein sampling). However, some tests are costly and unavailable in most hospitals.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the role of serum 18-hydroxycorticosterone (s18OHB), urinary and serum 18-hydroxycortisol (u- and s18OHF), and urinary and serum 18-oxocortisol (u- and s18oxoF) in the diagnosis of PA and its subtypes, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH).
  
  
  METHODS
  The study included 62 patients with low-renin essential hypertension (EH), 81 patients with PA (20 APA, 61 BAH), 24 patients with glucocorticoid-remediable aldosteronism, 16 patients with adrenal incidentaloma, and 30 normotensives.
  
  
  METHODS
  We measured s18OHB, s18OHF, and s18oxoF before and after saline load test (SLT) and 24-h u18OHF and u18oxoF.
  
  
  RESULTS
  PA patients displayed significantly higher levels of s18OHB, u18OHF, and u18oxoF compared to EH and normal subjects; APA patients displayed s18OHB, u18OHF, and u18oxoF levels significantly higher than BAH patients. Similar results were obtained for s18OHF and s18oxoF. SLT significantly reduced s18OHB, s18OHF, and s18oxoF in all groups, but steroid reduction was much less for APA patients compared to BAH and EH. The s18OHB/aldosterone ratio after SLT more than doubled in EH but remained unchanged in APA patients.
  
  
  CONCLUSIONS
  u18OHF, u18oxoF, and s18OHB measurements in patients with a positive aldosterone/plasma renin activity ratio correlate with confirmatory tests and adrenal vein sampling in PA patients. If verified, these steroid assays would refine the diagnostic workup for PA.
authors.affiliation: Department of Medicine and Experimental Oncology, Division of Internal Medicine and Hypertension Unit, University of Torino, and Clinical Chemistry Laboratory, San Giovanni Battista University Hospital, Via Genova 3, 10126 Torino, Italy. paolo.mulatero@libero.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Mulatero
authors.forename: Stefania Morra
authors.initials: SM
authors.lastname: di Cella
authors.forename: Silvia
authors.initials: S
authors.lastname: Monticone
authors.forename: Domenica
authors.initials: D
authors.lastname: Schiavone
authors.forename: Maria
authors.initials: M
authors.lastname: Manzo
authors.forename: Giulio
authors.initials: G
authors.lastname: Mengozzi
authors.forename: Franco
authors.initials: F
authors.lastname: Rabbia
authors.forename: Massimo
authors.initials: M
authors.lastname: Terzolo
authors.forename: Elise P
authors.initials: EP
authors.lastname: Gomez-Sanchez
authors.forename: Celso E
authors.initials: CE
authors.lastname: Gomez-Sanchez
authors.forename: Franco
authors.initials: F
authors.lastname: Veglio
mesh_terms: D015069:18-Hydroxycorticosterone / Q000097:blood*; D000328:Adult; D006801:Humans; D006854:Hydrocortisone / Q000031:analogs & derivatives* / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis*; D006973:Hypertension / Q000097:blood / Q000175:diagnosis*
chemical_list: C038135:18-oxocortisol; D015069:18-Hydroxycorticosterone; C033689:18-hydroxycortisol; D006854:Hydrocortisone