Resolution of paradoxical bilateral aldosterone suppression with mass spectrometry
Authors' conclusion
Apparent BAS derives primarily from artifacts in clinical immunoassays. These data caution against assuming that aldosterone suppression indicates contralateral aldosterone lateralization in cases with partial adrenal vein catheterization failure.
Study context
- Population
- Patients with confirmed primary aldosteronism (PA) who underwent adrenal vein sampling (AVS) at a referral center, 2015–2023
- Participants
- 402 patients
- Outcome
- Prevalence of paradoxical bilateral aldosterone suppression (BAS) in AVS without and with cosyntropin stimulation, based on clinical immunoassays
Methodological detailssingle referral centre, simultaneous AVS before and after cosyntropin stimulation, LC-MS/MS re-quantitation
- Single referral centre
- Simultaneous AVS before and after cosyntropin stimulation
- LC-MS/MS re-quantitation
Main finding
As reported in the abstract
BAS prevalence (immunoassay)
Bilateral aldosterone suppression (BAS) observed
102
25%
BAS pre-cosyntropin only
31
BAS post-cosyntropin only (incl. 10 without successful baseline catheterization)
48
BAS both pre- and post-cosyntropin
23
Observational data: associations, not effects.
Further findings
Lateralized PA by AVS among patients with BAS
- Pre-cosyntropin data
- 36%
- Post-cosyntropin data
- 43%
BAS by LC-MS/MS
- BAS not present by LC-MS/MS among patients with serum available
- 42/53 (79%)
Immunoassay vs LC-MS/MS agreement
- Immunoassays overestimated cortisol across the analytical range
- Immunoassays overestimated low aldosterone concentrations but underestimated high ones, such as in adrenal veins
Original publication
Resolution of paradoxical bilateral aldosterone suppression with mass spectrometry. Eur J Endocrinol. Published 15 April 2025. doi:10.
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