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Measurement of 18-Hydroxycorticosterone during Adrenal Vein Sampling for Primary Aldosteronism

Divisions of Endocrinology and Metabolism (R.J.A., S.S., N.C.), and of Hypertension (W.V., S.D.N., R.G.V.), Department of Internal Medicine, Division of Gastrointestinal and Endocrine Surgery, Department of Surgery (F.E.N., S.A.H.), Division of Vascular and Interventional Radiology, Department of Radiology (B.L.D., S.C.J., C.K.T., J.L.), and Departments of Pathology (F.H.W.) and of Clinical Sciences (D.L.), University of Texas Southwestern Medical Center, Dallas, Texas 75390-8857; and Endocrinology Laboratory (D.W.C.), Esoterix, Incorporated, Calabasas Hills, California 91301

Address all correspondence and requests for reprints to: Dr. Richard J. Auchus, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8857. E-mail: richard.auchus{at}UTSouthwestern.edu.

Context: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA.

Objectives: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA.

Design, Setting, and Subjects: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals.

Main Outcome Measures: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios.

Results: The 18OHB/A ratios were much lower in blood draining APAs (2.17 ± 0.62) than in blood draining the contralateral adrenals (12.96 ± 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 ± 4.32; P = 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 ± 11.51) compared with IHA adrenals (9.22 ± 5.18; P < 0.001) or the contralateral adrenals (6.23 ± 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases.

Conclusions: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.