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Blood tests may offer alternative to ‘highly invasive’ adrenal venous sampling
Blood samples from patients with unilateral hyperaldosteronism revealed higher aldosterone concentrations when compared with patients with bilateral hyperaldosteronism, providing a possible alternative to invasive adrenal venous sampling used to diagnose primary aldosteronism subtypes, according to research in Clinical Endocrinology.
“[Adrenal venous sampling], the most reliable method for distinguishing unilateral from bilateral disease, is time consuming, highly invasive and has a low success rate,” Hiroki Kobayashi, of the division of nephrology, hypertension and endocrinology at Nihon University School of Medicine in Tokyo, and colleagues wrote. “Thus, a simpler, noninvasive and inexpensive method for differentiating [unilateral hyperaldosteronism] from [bilateral hyperaldosteronism] is urgently needed.”
Kobayashi and colleagues conducted a retrospective analysis of 64 patients diagnosed with primary aldosteronism who underwent adrenal venous sampling between January 2006 and August 2015. Within the cohort, 32 patients were diagnosed with unilateral hyperaldosteronism; 22 patients were diagnosed with bilateral hyperaldosteronism. Researchers measured peripheral aldosterone, cortisol, adrenocorticotropic hormone and plasma renin activity with blood samples obtained at midnight, 6 a.m., noon and 6 p.m., and measured 24-hour urinary aldosterone levels.
Plasma aldosterone concentrations were significantly different between the unilateral and bilateral hyperaldosteronism groups at all times, particularly at 6 a.m. when concentrations were significantly higher in unilateral compared with bilateral hyperaldosteronism (P < .0001). Researchers found that plasma aldosterone concentrations at 6 a.m. had the highest diagnostic ability, with an area under the curve of 0.922 at a cutoff value of 217.5 pg/mL, with 90% sensitivity and 83.3% specificity.
Researchers also found that 24-hour urinary aldosterone levels in unilateral hyperaldosteronism patients correlated with 6 a.m. plasma aldosterone concentrations (P < .0001).
“Our study suggested two important clinical findings,” the researchers wrote. “Firstly, [plasma aldosterone concentration] at any time point, but especially at 6 a.m., can be used to discriminate [unilateral hyperaldosteronism] from [bilateral hyperaldosteronism] in patients with [primary aldosteronism]. Secondly, 24-hour urinary aldosterone levels can be used to differentiate unilateral from bilateral disease.” – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.