Home measurement of 24-hour corticosteroid dynamics in primary aldosteronism

Marianne Aardal Grytaas; Thomas Upton; Isabella Marinelli; Paal Methlie; Marianne Oksnes; Dimitra Vassiliadi; Sophie Bensing; Georgina Russell; Kristian Lovas; Dimitris Margaritopoulos; Ileana R. Botusan; Katerina Simunkova; Maria Balomenaki; Katarina Berinder; Belinda Lombard; Thea Sjogren; Ida Lovik; Bergithe Oftedal; Grethe Ueland; Anette Heie; Olle Kampe; Stylianos Tsagarakis; Stafford Lightman; Eder Zavala; Eystein Sverre Husebye

doi:10.1530/endoabs.110.OC13.3

OC13.3

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Endocrine Abstracts (2025) 110 OC13.3 | DOI: 10.1530/endoabs.110.OC13.3

ECEESPE2025 Oral Communications Oral Communications 13: Adrenal and Cardiovascular Endocrinology Part 2 (6 abstracts)

Home measurement of 24-hour corticosteroid dynamics in primary aldosteronism

Marianne Aardal Grytaas ¹ , Thomas Upton ² , Isabella Marinelli ³ , Paal Methlie ⁴ , Marianne Oksnes ⁵ , Dimitra Vassiliadi ⁶ , Sophie Bensing ⁷ , Georgina Russell ³ , Kristian Løvås ⁵ , Dimitris Margaritopoulos ⁶ , Ileana R. Botusan ⁷ , Katerina Simunkova ⁴ , Maria Balomenaki ⁶ , Katarina Berinder ⁷ , Belinda Lombard ³ , Thea Sjøgren ⁵ , Ida Løvik ⁵ , Bergithe Oftedal ⁴ , Grethe Ueland ⁵ , Anette Heie ⁵ , Olle Kämpe ⁷ , Stylianos Tsagarakis ⁶ , Stafford Lightman ² , Eder Zavala ³ & Eystein Sverre Husebye ⁴

Author affiliations

¹Haukeland University Hospital, Department of Medicine, Bergen, Norway; ²University of Bristol, Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, Translational Health Sciences, Faculty of Health Sciences, Bristol, United Kingdom; ³University of Birmingham, Centre for Systems Modelling and Quantitative Biomedicine, School of Medical Sciences, Birmingham, United Kingdom; ⁴University of Bergen, Haukeland University Hospital, Department of Clinical Science, Faculty of Medicine, Bergen, Norway; ⁵Haukeland University Hospital, University of Bergen, Department of Medicine, Bergen, Norway; ⁶Evangelismos Hospital, Department of Endocrinology, Athens, Greece; ⁷Karolinska University Hospital, Karolinska Institute, Department of Endocrinology, Stockholm, Sweden

JOINT561

Background: Primary aldosteronism (PA) is common, affecting 5-20% of the hypertensive population and is associated with an increased cardiovascular risk and incidence of metabolic disease when compared with primary hypertension. To date, establishing a correct diagnosis is hampered by laborious and time-consuming protocols unable to capture the pulsatile variability of aldosterone across the day. In this study we applied a dynamic hormone profiling technique to study the dynamics of aldosterone and other corticosteroids in patients with established PA to lay the foundation for new diagnostic procedures and criteria.

Methods: Sixty PA patients were recruited, 26 unilateral, 24 bilateral, and 10 with undetermined PA subtype. Ambulatory 24-hour profiles of corticosteroids including aldosterone and the hybrid steroids 18-hydroxycortisol and 18-oxocortisol were quantified in subcutaneous tissue microdialysate by liquid chromatography tandem mass spectrometry and compared with 215 healthy participants. Specific dynamic features were extracted and used to develop a machine learning model to distinguish PA profiles from healthy normal variation.

Results: PA profiles under unstimulated conditions were characterised by a pulsatile secretion and diurnal rhythmicity of aldosterone, cortisol, intermediary steroids and hybrid steroids. Nocturnal and early morning hypersecretion of aldosterone, 18-hydroxycortisol and 18-oxocortisol was prominent in unilateral PA. 18-oxocortisol was seen almost exclusively in unilateral PA, both with and without somatic KCNJ5-mutations. 24-hour cortisol concentrations did not differ between PA and healthy participants. Applying dynamic hormone profiling with a machine learning classifier algorithm resulted in a diagnostic sensitivity of 88% and specificity of 80% in predicting PA. Normalisation of aldosterone hypersecretion was observed after adrenalectomy for unilateral PA.

Conclusions: 24-hour tissue corticosteroid profiling in the home setting is achievable and reveals new insights into the pathophysiology of PA, characterised by nocturnal hypersecretion of aldosterone and hybrid steroids. The technique holds promise for faster and more accurate PA diagnosis with identification of unilateral cases.