Mass Spectrometric Measurements of 11‐Deoxycortisol, Androstenedione and Dehydroepiandrosterone Are Superior to Cortisol to Assess Selectivity of Non‐Stimulated Adrenal Vein Sampling
Authors' conclusion
11-Deoxycortisol, androstenedione and dehydroepiandrosterone are more suitable biomarkers than cortisol to assess AVS selectivity and allow rescue of many procedures otherwise deemed unsuccessful. Measurements of cortisol to assess AVS selectivity are best replaced by mass spectrometric measurements of other steroids.
Study context
- Population
- Patients undergoing unstimulated adrenal venous sampling (AVS) for subtyping primary aldosteronism
- Participants
- 229 patients
- Exposure
- 11-Deoxycortisol, androstenedione and DHEA vs cortisol (mass spectrometry) to assess AVS selectivity
- Outcome
- Selectivity index (fold higher than cortisol)
Methodological detailsmulticenter
- Multicenter
Main finding
As reported in the abstract
Fold higher selectivity index
5.7
CI 5.1–6.2P < 0.0001
11-deoxycortisol vs cortisol
Fold higher selectivity index
5.1
CI 4.8–5.4P < 0.0001
androstenedione vs cortisol
Fold higher selectivity index
5.9
CI 5.5–6.4P < 0.0001
dehydroepiandrosterone vs cortisol
Observational data: associations, not effects.
Further findings
Bilateral successful AVS, selectivity index cut-off ≥ 3
Bilateral successful AVS, selectivity index cut-off ≥ 2
- Bilateral successful AVS, selectivity index cut-off ≥ 3 — All three steroids higher than cortisol
- p < 0.0001
- Bilateral successful AVS, selectivity index cut-off ≥ 2 — All three steroids higher than cortisol
- p < 0.0001
Apparent unsuccessful AVS procedures
- Reduced with 11-deoxycortisol vs cortisol
- 54%-72%
Lateralised aldosterone secretion
- No clear advantages of any single steroid over the others
Original publication
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