Adrenal Venous Sampling Using Metanephrine in Primary Aldosteronism With or Without Cortisol Cosecretion
Authors' conclusion
Metanephrine was superior to cortisol after cosyntropin for assessing selectivity and equivalent to cortisol for lateralization. Moreover, MACS did not impact lateralization in AVS under cosyntropin in most cases.
Study context
- Population
- Consecutive patients with primary aldosteronism (PA) and indication for adrenal venous sampling (AVS), with or without mild autonomous cortisol secretion (MACS)
- Participants
- 58 patients
- Comparison
- Plasma metanephrine vs cortisol for AVS selectivity and lateralization
- Outcome
- Performance of plasma metanephrine in AVS for determining aldosterone lateralization in PA
Methodological detailsconsecutive patients, sequential AVS under cosyntropin stimulation
- Consecutive patients
- Sequential AVS under cosyntropin stimulation
Performance
As reported in the abstract
SIMN >6.45: sensitivity and specificity for identifying successful catheterization, outperforming the cut-off of 12
100%
Correlation of LIA/MN and LIA/C
r = 0.752
P < .001
PA lateralization concordant (metanephrine vs cortisol)
93.1%
Discordant cases (unilateral PA by cortisol, bilateral by metanephrine), with nonclassical histology
2
Further findings
SIMN, right vs left adrenal vein
- Right SIMN
- 127.91 nmol/L [78.12, 239.12]
- Left SIMN
- 46.16 nmol/L [26, 73.87]
- Right vs left SIMN
- P < 0.001
SIMN vs SIC correlation
- Right adrenal vein
- r = 0.518, P < .001
- Left adrenal vein
- r = 0.435, P < .001
SIMN > 12 with SIC between 3 and 5
- Cases; SIC > 3 sufficient to confirm successful cannulation
- 6
MACS
- MACS identified
- 15 out of 58 patients (25.86%)
- MACS generally did not influence AVS lateralization, except when aldosterone and cortisol were secreted by different adrenal lesions
Original publication
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