Adrenal androgens versus cortisol for primary aldosteronism subtype determination in adrenal venous sampling.

Content Provider	Europe PMC
Author	Viukari, Marianna Kokko, Eeva Pörsti, Ilkka Leijon, Helena Vesterinen, Tiina Hinkka, Tero Soinio, Minna Schalin‐Jäntti, Camilla Matikainen, Niina Nevalainen, Pasi I.
Abstract	AbstractObjectiveWe examined if measurement of adrenal androgens adds to subtype diagnostics of primary aldosteronism (PA) under cosyntropin‐stimulated adrenal venous sampling (AVS).DesignA prospective pre‐specified secondary endpoint analysis of 49 patients with confirmed PA, of whom 29 underwent unilateral adrenalectomy with long‐term follow‐up.MethodsConcentrations of androstenedione, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEAS) were measured during AVS in addition to aldosterone and cortisol. Subjects with lateralisation index (LI) of ≥4 were treated with unilateral adrenalectomy, and the immunohistochemical subtype was determined with CYP11B2 and CYP11B1 stains. The performance of adrenal androgens was evaluated by receiver operating characteristics (ROC) curve analyses in adrenalectomy and medical therapy groups.ResultsDuring AVS, the correlations between cortisol and androstenedione, DHEA and DHEAS for LI and selectivity index (SI) were highly significant. The right and left side SIs for androstenedione and DHEA were higher (p < .001) than for cortisol. In ROC analysis, the optimal LI cut‐off values for androstenedione, DHEA and DHEAS were 4.2, 4.5 and 4.6, respectively. The performance of these LIs for adrenal androgens did not differ from that of cortisol.ConclusionsUnder cosyntropin‐stimulated AVS, the measurement of androstenedione and DHEA did not improve the cannulation selectivity. The performance of cortisol and adrenal androgens are confirmatory but not superior to cortisol‐based results in lateralisation diagnostics of PA.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC9544970&blobtype=pdf
Page Count	9
ISSN	03000664
Journal	Clinical Endocrinology [Clin Endocrinol (Oxf)]
Volume Number	97
DOI	10.1111/cen.14691
PubMed Central reference number	PMC9544970
Issue Number	3
PubMed reference number	35167715
e-ISSN	13652265
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2022-03-11
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. © 2022 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.
Subject Keyword	adrenal androgens adrenal venous sampling aldosterone producing adenoma bilateral adrenal hyperplasia CYP11B2 primary aldosteronism subtype classification of primary aldosteronism
Content Type	Text
Resource Type	Article
Subject	Endocrinology, Diabetes and Metabolism Endocrinology