ECE2024 Poster Presentations Adrenal and Cardiovascular Endocrinology (95 abstracts)
Improved selectivity of adrenal venous sampling with the use of alternative steroids to cortisol
Francesco Alessi 1 , Georgiana Costantinescu 1 , Mirko Peitzsch 2 , Hanna Remde 3 , Lydia Kürzinger 3 , Manuel Schulze 4 , Myron Lee 5 , Jun Yang 6 , Martin Reinke 7 , Felix Beuschlein 8 , Stefan Bornstein 1 , Jacques Lenders 1,9 , Christina Pamporaki 1 & Graeme Eisenhofer 1
1University Hospital Carl Gustav Carus, Technische Universität Dresden, Department of Internal Medicine III, Dresden, Germany; 2Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Institute of Clinical Chemistry and Laboratory Medicine, Dresden, Germany; 3University Hospital, University of Würzburg, Department of Internal Medicine I, Division of Endocrinology and Diabetes, Würzburg, Germany; 4Technische Universität Dresden, Center for Interdisciplinary Digital Sciences, Department Information Services and High Performance Computing, Dresden, Germany; 5Prince of Wales Hospital, Department of Chemical Pathology, NSW Health Pathology, Sydney, Australia; 6Hudson Institute of Medical Research, Centre for Endocrinology and Metabolism, Clayton, Australia; 7University Hospital, Ludwig Maximilian University Munich, Department of Medicine IV, Munich, Germany; 8University Hospital Zurich and the LOOP Zurich Medical Research Center, Department of Endocrinology, Diabetology and Clinical Nutrition, Zurich, Switzerland; 9Radboud University Medical Center, Department of Internal Medicine, Nijmegen, Netherlands
Background: Current guidelines recommend adrenal vein sampling (AVS) for the identification of surgically treatable unilateral disease among patients with primary aldosteronism (PA). The cortisol-derived selectivity index (SI) is currently used to assess the success (or selectivity) of adrenal vein catheterization during AVS. However, AVS studies can be non-selective in many cases.
Aim: To examine whether the use of SI derived either from 11-deoxycortisol, DHEA or androstenedione assessed by liquid chromatography with tandem mass spectrometry (LC–MS/MS) could improve the selectivity rate of AVS compared to the cortisol-derived SI measured by immunoassay (IA) methods.
Design and methods: This prospective multicenter cohort study involved 160 patients from 7 centers located in 3 countries who underwent AVS without cosyntropin stimulation. Cortisol was assessed by IA and LC–MS/MS, whereas 11-deoxycortisol, DHEA and androstenedione were assessed only by LC–MS/MS. A SI of 3 was considered the cut-off for selectivity.
Results: The AVS selectivity rate was 76.9% (123/160) using the cortisol-derived SI assessed by IA. For the majority of patients with unsuccessful AVS, selectivity failed on the right side (21/37) or on both sides (12/37). Selectivity rates using cortisol-derived SI assessed by LC–MS/MS did not differ. Nevertheless, the use of SI derived by either 11-deoxycortisol, DHEA or androstenedione increased the selectivity success rate of AVS to 90.6% (P<0.001), 90% (P<0.001), and 90.6% respectively (P<0.001). DHEA showed the highest median SI values compared to all other steroids, with 4-fold higher median SI values for the left side and 8-fold for the right side compared to IA cortisol (P<0.001).
Conclusions: SI derived either from 11-deoxycortisol, DHEA, or androstenedione and assessed by LC–MS/MS yields a significantly higher selectivity rate for AVS than that derived from cortisol measured by both IA and LC–MS/MS. Our findings have immediate application in daily clinical practice.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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