ECE2016 Guided Posters Adrenal (10 abstracts)
Is steroid profiling using LC-MS/MS useful in the diagnostic work-up of primary aldosteronism?
Tracy A. Williams 1, , Jacques W.M. Lenders 3, , Mirko Peitzsch 5 , Tanja Dekkers 3 , Anna S. Dietz 1 , Lars C. Rump 6 , Holger S. Willenberg 7, , Marcus Treitl 9 , Martin Bidlingmaier 1 , Felix Beuschlein 1 , Jaap Deinum 3 , Graeme Eisenhofer 4, & Martin Reincke 1
1Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany; 2Division of Internal Medicine and Hypertension, Department of Medical Sciences, University of Turin, Turin, Italy; 3Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; 4Department of Internal Medicine III, Technische Universität Dresden, Dresden, Germany; 5Institute of Clinical Chemistry and Laboratory Medicine, Technische Universität Dresden, Dresden, Germany; 6Medical Faculty, Department of Nephrology, University Dusseldorf, Dusseldorf, Germany; 7Medical Faculty, Department of Endocrinology, Diabetes and Metabolism, University Dusseldorf, Dusseldorf, Germany, 8Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany; 9Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
Introduction: Primary aldosteronism (PA) is mainly caused by unilateral aldosterone-producing adenomas (APA) or bilateral adrenal hyperplasia (BAH). Subtype differentiation relies on the invasive and technically challenging adrenal venous sampling (AVS). We recently demonstrated the potential utility of peripheral plasma steroid profiling by LC-MS/MS to distinguish APA and BAH. We tested the following hypotheses: first, if steroid profiling in combination with AVS, effectively identifies patients with unilateral disease who are candidates for surgery and second, if steroid profiling identifies those patients with a high likelihood for BAH in whom AVS may be avoided.
Methods: Two hundred and eight confirmed PA patients underwent computed tomography, AVS and steroid profiling of peripheral plasma by LC-MS/MS. Long-term outcome of adrenalectomy was assessed by clinical and biochemical re-evaluation in all subjects. The diagnostic accuracy for subtyping PA patients was calculated based on different strategies for PA subtype differentiation and compared to the gold standard of AVS.
Results: The diagnostic accuracy of AVS was 97%, with 6 out of 121 APA patients incorrectly classified on the basis of persistent PA following adrenalectomy. Steroid profiling correctly classified 79% of PA patients but this does not identify the adrenal source of aldosterone excess for the APA group. The most effective strategy in our model was steroid profiling followed by selective AVS in those patients designated by peripheral venous steroid profiling to have high likelihood of an APA. Here, 20 patients would have been falsely classified and treated as BAH while 6 patients with BAH falsely classified as APA by AVS would have been spared unnecessary adrenalectomy. Notably, the requirements for AVS would have been reduced by 43%.
Conclusion: Steroid profiling followed by AVS in the APA group could provide an alternative to AVS alone for subtype differentiation in PA patients, thereby significantly reducing the need for AVS.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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