Plasma metanephrine for assessing the selectivity of adrenal venous sampling

Tanja Dekkers; Jaap Deinum; Leo Schultze Kool; Dirk Blondin; Oliver Vonend; Ad Hermus; Mirko Peitzsch; Lars Rump; Gerald Antoch; Fred Sweep; Jacques Lenders; Stefan Bornstein; Holger Willenberg; Graeme Eisenhofer

doi:10.1530/endoabs.32.P8

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Endocrine Abstracts (2013) 32 P8 | DOI: 10.1530/endoabs.32.P8

ECE2013 Poster Presentations Adrenal cortex (64 abstracts)

Plasma metanephrine for assessing the selectivity of adrenal venous sampling

Tanja Dekkers ¹ , Jaap Deinum ¹ , Leo Schultze Kool ¹ , Dirk Blondin ² , Oliver Vonend ² , Ad Hermus ¹ , Mirko Peitzsch ³ , Lars Rump ² , Gerald Antoch ² , Fred Sweep ¹ , Jacques Lenders ^1, , Stefan Bornstein ³ , Holger Willenberg ^2, & Graeme Eisenhofer ³

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¹Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; ²University Medical Center Düsseldorf, Dusseldorf, Germany; ³University Hospital Carl Gustav Carus, Dresden, Germany.

Context: More reliable parameters than cortisol are needed for assessing correct catheter positioning during adrenal vein sampling (AVS). Plasma metanephrine represents one such alternative.

Objective: To determine the utility of adrenal venous (AV) plasma concentrations of metanephrine to establish correct catheter positioning during AVS.

Design and methods: We included 86 AVS procedures: 52 ACTH-stimulated and 34 non-stimulated sequential procedures. Plasma cortisol, metanephrine, normetanephrine, epinephrine and norepinephrine concentrations were measured in AV and peripheral venous (PV) samples. AVS success rates, according to cortisol AV:PV selectivity indices of 2.0 and 3.0, were compared with that for metanephrine using a selectivity index (SI) determined by ROC curve analysis.

Results: Among AVS procedures assessed as selective using a cortisol SI of 3.0, the median AV:PV plasma metanephrine ratio was 6-fold higher than that for cortisol (94.0 vs 15.5, P<0.0001). There were significant positive relationships between AV:PV ratios for cortisol and metanephrine for ACTH-stimulated samplings, but not for non-stimulated samplings. ROC curve analysis indicated a plasma metanephrine SI cut-off of 10. There was 96% concordance in AVS success rates determined by cortisol and metanephrine derived SIs in ACTH-stimulated AVS. Without stimulation, the concordance was 82 and 56% for at respective SIs of 2.0 and 3.0; AVS success rates determined by metanephrine (91%) were higher than those determined by cortisol (56 and 79% for respective SIs of 3.0 and 2.0).

Conclusions: Metanephrine provides an alternative analyte to cortisol for sensitive assessment of AVS selectivity that appears particularly advantageous in sampling performed without ACTH stimulation.