Noninvasive serum steroid signatures of lateralization and coexisting cortisol excess in primary aldosteronism
Authors' conclusion
Serum steroid profiling may facilitate the noninvasive identification of lateralized PA beyond clinical parameters alone. Coexisting MACS was associated with androgen suppression and altered steroid patterns, while the prognostic role of steroid profiles for treatment outcomes requires further investigation.
Study context
- Population
- Patients with primary aldosteronism (PA) who underwent adrenal venous sampling (AVS) between 2018 and 2022patients with PA who underwent AVS, enrolled
- Participants
- 216 patients
- Index test or model
- Peripheral steroid profiles as a noninvasive tool for PA subtyping; AVS is the gold standard
- Target condition
- lateralized PA
Methodological detailsserum steroid profiling by liquid chromatography-mass spectrometry, random forest-based recursive feature elimination, receiver operating characteristic analysis
- Serum steroid profiling by liquid chromatography-mass spectrometry
- Random forest-based recursive feature elimination
- Receiver operating characteristic analysis
Performance
As reported in the abstract
| Test or model | AUC |
|---|---|
| THREE-STEROID MODEL | 0.821 |
| CLINICAL MODEL | 0.790 |
| COMBINED MODEL | 0.852 |
AUC
THREE-STEROID MODEL0.821
CLINICAL MODEL0.790
COMBINED MODEL0.852
- Between THREE-STEROID MODEL and CLINICAL MODEL: P = 0.351 — discrimination comparable
- Between COMBINED MODEL and CLINICAL MODEL: P = 0.002 — combined model significantly outperformed the clinical model
Further findings
Aldosterone and 18-OHF, lateralized vs bilateral PA
- Lateralized PA showed significantly higher aldosterone and 18-hydroxycortisol (18-OHF) than bilateral PA
- P < 0.001
11-OHA4, lateralized vs bilateral PA
- Lateralized PA showed lower 11-hydroxyandrostenedione (11-OHA4) than bilateral PA
- P = 0.001
18-OHF levels in patients with lateralized PA and mild autonomous cortisol secretion (MACS)
- Patients with lateralized PA and MACS had higher 18-OHF levels
- age/sex-adjusted P=0.038
Post-surgical biochemical success
- Baseline steroid markers were not significantly associated with post-surgical biochemical success
- P > 0.05
Original publication
Noninvasive serum steroid signatures of lateralization and coexisting cortisol excess in primary aldosteronism. J Clin Endocrinol Metab. Published 10 November 2026. doi:10.
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