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This version published online on May 1, 2007
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-2631
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Submitted on November 29, 2006
Accepted on April 24, 2007

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

Richard J. Auchus*, Donald W. Chandler, Sarita Singeetham, Neema Chokshi, Fiemu E. Nwariaku, Bart L. Dolmatch, Shelby A. Holt, Frank H. Wians Jr., Shellie C. Josephs, Clayton K. Trimmer, Jorge Lopera, Wanpen Vongpatanasin, Shawna D. Nesbitt, David Leonard, and Ronald G. Victor

Divisions of Endocrinology & Metabolism (R.J.A., S.S., N.C.) and 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 & Interventional Radiology, Department of Radiology (B.L.D., S.C.J., C.K.T, J.L.); Department of Pathology (F.H.W.); and Department of Clinical Sciences (D.L.), UT Southwestern Medical Center, Dallas, TX, 75390-8857; and Endocrinology Laboratory (D.W.C.), Esoterix, Inc., Calabasas Hills, CA, 91301

* To whom correspondence should be addressed. E-mail: richard.auchus{at}UTSouwthwestern.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 to 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, 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 to IHA adrenals (9.22 ± 5.18, p<0.001) or the contralateral adrenals (6.23 ± 2.97, p<0.001). Using 18OHB/F gradient >2 or 18OHB/A gradient <0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21/23 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.
Key words: primary aldosteronism • adrenal vein sampling • aldosterone-producing adenoma • 18-hydroxycorticosterone • LC-MSMS • idiopathic hyperaldosteornism






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