Investigation of alternative hormones for evaluating selectivity of adrenal vein sampling in the subtype diagnosis of primary aldosteronism

Federico Ponzetto; Giulia Montesano; Matteo Procopio; Laura Leoni; Fabio Settanni; Ezio Ghigo; Giulio Mengozzi; Mirko Parasiliti Caprino

doi:10.1530/endoabs.110.P148

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Endocrine Abstracts (2025) 110 P148 | DOI: 10.1530/endoabs.110.P148

ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)

Investigation of alternative hormones for evaluating selectivity of adrenal vein sampling in the subtype diagnosis of primary aldosteronism

Federico Ponzetto ¹ , Giulia Montesano ² , Matteo Procopio ¹ , Laura Leoni ² , Fabio Settanni ³ , Ezio Ghigo ¹ , Giulio Mengozzi ^2,3 & Mirko Parasiliti Caprino ¹

Author affiliations

¹Endocrinology, Diabetology and Metabolism; University of Turin, Turin, Italy; ²Clinical Biochemistry Laboratory; University of Turin, Turin, Italy; ³Clinical Biochemistry Laboratory; City of Health of Science University Hospital, Turin, Italy

JOINT1348

Background-Aim: International guidelines recommend adrenal venous sampling (AVS) for subtype diagnosis of primary aldosteronism (PA), which is crucial for suggesting surgical or medical treatment. Successful cannulation of adrenal veins is assessed using the cortisol (F) ratio between adrenal and peripheral veins (selectivity index, SI). Given the limitations associated with F measurements, this study aimed to evaluate whether the measurement of other hormones could improve SI calculation.

Methods: The study included 122 PA patients undergoing unstimulated and sequential AVS. Concentrations of F, catecholamines (noradrenaline, NA, adrenaline, AD), metanephrines (normetanephrine, NMT, metanephrine, MT, normetanephrine, NMT), and other steroids (DHEA, DHEAS, androstenedione, A4, 11-deoxycorticosterone, DOC, 17-hydroxyprogesterone, 17OHP, and progesterone, P) were measured in both adrenal vein and peripheral vein samples using CLIA, HPLC, and LC–MS/MS, respectively. Hormone-specific SI cut-offs were calculated along with the percentage of selective procedures identified based on each marker. Additionally, differences in SI values of all hormones were compared between the selective and non-selective procedure groups.

Results: Using as reference cut-off SI=3 for F, ROC curve analysis revealed the following SI cut-offs for MT (11.90, AUC=0.640), NMT (1.65, AUC=0.640), NA (1.40, AUC=0.598), AD (1.50, AUC=0.557), DHEA (1.10, AUC=0.850), DHEAS (22.00, AUC=0.831), A4 (16.66, AUC=0.825), DOC (4.49, AUC=0.950), 17OHP (4.62, AUC=0.944), and P (4.75, AUC=0.829). All markers, except P, improved the rate of selective procedures compared to F (74.1%). Notably, only steroid hormones exhibited significantly higher SI values in the group of selective procedures, with increases of up to 10-fold for DOC and 17OHP.

Conclusions: The monitoring of alternative hormones and the use of hormone-specific SI cut-offs increased the rate of selective AVS procedures, with steroids demonstrating the best diagnostic accuracy compared to metanephrines and catecholamines. In the evaluation of successful cannulations, the highest increases in SI were observed for DOC and 17-OHP, highlighting the latter as a promising additional marker due to its easily measurable levels in both adrenal and peripheral veins.