SFEBES2008 Oral Communications Tumours, diabetes, bone (8 abstracts)
Serum 18 hydroxycortisol identifies aldosteronoma in the differential diagnosis of primary aldosteronism
Sowmya Narasimhan 1,2 , Alan McGregor 1,2 , John Miell 1,2 , Susan Mary Chambers 1,2 , Hagosa Demoz Abraha (Daines) 1,2 & Simon Aylwin 1,2
1King’s College Hospital, London, UK; 2University Hospital Lewisham, London, UK.
Introduction: 18-hydroxycortisol (18-OHF) is known to be elevated in glucocorticoid remediable aldosteronism but there are few data relating to 18-OHF in the differential diagnosis of primary aldosteronism.
Aim: We evaluated the usefulness of lying and standing 18-OHF in patients with primary aldosteronism in differentiating between aldosteronoma, bilateral adrenal hyperplasia (BAH) and normality.
Methods: Patients (n=27) with an elevated aldosterone renin ratio (ARR) were further evaluated by assessing lying and standing aldosterone, renin, cortisol and 18-OHF after salt loading. 18-OHF levels (in house flouro-immuno assay, Delfia method) were compared according to adenoma (histological confirmation), BAH (no lesion on imaging with consistent biochemistry) and normality (normalisation of ARR after salt loading).
Results: All data given as mean (range).
| Aldosteronoma (n=9) | BAH (n=12) | Normal ARR (n=6) | |
| Mean 18-OHF (nmol/l) lying | 10.4 (4.1–21.1) | 4.2 (2.1–6.4) | 2.6 (2.0–3.7) |
| Mean 18-OHF (nmol/l) standing | 12.5 (8.4–22.8) | 5 (2.3–7.3) | 4 (2.6–6.2) |
Recumbent 18-OHF levels were greater in adenomas than patients with hyperplasia (P≤0.001) and patients with normal ARR (P−<0.01) This was even more clear cut with standing 18-OHF where there was no overlap between adenoma and BAH (P≤0.001).
Conclusion: Although a sub centimetre angiotensin 2 sensitive adenoma might be classified as BAH in our data, 18-OHF is a potentially valuable tool in discriminating adenoma from hyperplasia.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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