Role Of Adrenal Vein Sampling In Differential Diagnosis Of Adrenal Diseases And Related Problems

Part I Role of adrenal vein sampling in differential diagnosis of primary aldosteronism subtypesObjective:To investigate the usefulness of adrenal vein sampling(AVS)in identifying the subtype of primary aldosteronism(PA).Methods:AVS was performed in 71 cases of patients of confirmed PA from September 2010 to February 2018 in Nanjing Drum Tower Hospital.Clinical,biochemical and follow-up data were reviewed retrospectively.We used bilaterally simultaneous catheterization without cosyntropin stimulation,and used contemporaneous cortisol measurement during AVS.Selectivity Index(S1)? 1.5 suggested the sample was from the adrenal vein.Lateralization index(LI)>2 suggested unilateral disease.We further compared the clinical data and analysed the AVS findings.Results:AVS was successful in 62 cases of 71 patients,and the success rate was 87.3%.According to the results of AVS and postoperative pathology,62 cases were divided to aldosterone-producing adenoma(APA)/unilateral adrenal hyperplasia(UAH)group(39 cases,54.9%)and idiopathic hyperaldosteronism(IHA)group(23 cases,32.4%).Compared with IHA group,patients with APA/UAH showed higher proportion of hypokalemia(92.3%vs 69.6%,P = 0.019).Furthermore,patients with APA/UAH demonstrated high plasma aldosterone concentration(P = 0.010).The diagnosis concordance between CT and adrenal vein sampling was only 58.1%.Conclusion:The application of bilaterally simultaneous catheterization and contemporaneous cortisol measurement improves success rate and diagnosis accuracy of AVS.AVS is useful in subtyping diagnosis of PA with equivocal imaging findings.Part ? Adrenal Androgens Measurement for Assessing the Selectivity of Adrenal Venous Sampling in Primary AldosteronismObjective:Adrenal venous sampling(AVS)is the reference standard for primary aldosteronism(PA)subtyping.Cortisol is widely used to assess the success of selective AVS,but it is not always reliable.The aim of the present study was to investigate the usefulness of adrenal androgens,compared to cortisol,in assessing the selectivity of AVS.Methods:We recruited 37 consecutive PA patients undergoing AVS.The AVS procedures were performed with the bilateral simultaneous technique without cosyntropin stimulation.To measure the variability of the tested hormones with time,blood samples were collected twice at baseline in 10 patients,with a 15-min interval between time-15 and 0.Concentrations of cortisol,androstenedione,dehydroepiandrosterone(DHEA)and DHEA sulfate(DHEAS)were measured in adrenal and peripheral venous(AV,PV)samples.Results:We demonstrated that Selectivity Index(SI)based on androstenedione and DHEA were on average,3.0-and 2.0-fold higher than SI of cortisol,respectively(P<0.05).Whereas,the Sl based on DHEAS is 5.0-fold smaller than SI of cortisol(P<0.05).Plasma androstenedione and DHEA concentrations positively correlated with cortisol and aldosterone in AV samples(P<0.01).Compared to cortisol,the variation ratio of AV androstenedione and DHEA was lower from t-15 to to(0.23,0.43;vs 0.52,p = 0.001,p = 0.061 respectively).Using the receiver operating characteristic curve,a SI ? 3 for androstenedione or DHEA provided optimal sensitivity and specificity in AVS.Conclusion:Given the much larger AV/PV ratios and reduced variability compared to cortisol,the adrenal androgens androstenedione and DHEA are useful for assessing the selectivity of AVS without cosyntropin stimulation and may be superior analytes in conditions with marked variability of cortisol levels or with adrenocortical tumors cosecreting cortisol and aldosterone.