ECE2019 Poster Presentations Adrenal and Neuroendocrine Tumours 2 (60 abstracts)
Measurement of metanephrine in adrenal venous sampling may help subtyping primary aldosteronism
Stephanie Baron 1, , Clement Bailly 3 , Erica Cornu 3 , Anne Blanchard 2, , Damien Bergerot 4 , Jean-Yves Pagny 6 , Pierre-Yves Laffy 6 , Thierry Carrere 6 , Christine Grataloup 6 , Franck Zinzindohoue 7 , Yves Reznik 8 , Michel Azizi 2, , Eliane Billaud 2, & Laurence Amar 2,
1Assistance Publique Hôpitaux de Paris (APHP) Georges Pompidou European Hospital, Physiology Department, PARIS, France; 2Paris Descartes University, PARIS, France; 3Assistance Publique Hôpitaux de Paris (APHP) Georges Pompidou European Hospital, Hypertension Unit, PARIS, France; 4Assistance Publique Hôpitaux de Paris (APHP) Georges Pompidou European Hospital, Clinical Investigations Center 1418, PARIS, France; 5INSERM UMRS 1138 CNRS ERL 8228, PARIS, France; 6Assistance Publique Hôpitaux de Paris (APHP) Georges Pompidou European Hospital, Radiology, Department, PARIS, France; 7Assistance Publique Hôpitaux de Paris (APHP) Georges Pompidou European Hospital, Surgery Department, PARIS, France; 8Caen Hospital, Endocrinology Department, Caen, France; 9Assistance Publique Hôpitaux de Paris (APHP) Georges Pompidou European Hospital, Pharmacology Department, PARIS, France; 10INSERM UMR 970, Paris Cardiovascular Research Center, PARIS, France.
Objective: Adrenal venous sampling (AVS) is the gold standard method to assess lateralization of aldosterone secretion in patients with primary aldosteronism (PA). The selectivity index (SIcortisol, the adrenal to peripheral vein ratio of cortisol concentrations) determines correct catheter positioning during AVS. The lateralization index (LIcortisol, the aldosterone to cortisol ratios between adrenal veins) distinguishes unilateral aldosterone producing adenoma (APA) from bilateral adrenal hyperplasia (BAH). The use of cortisol is not always reliable and the ratio of adrenal to peripheral vein free metanephrine concentrations has been alternatively suggested for SI determination. The aim of our study was to assess the performance of SImetanephrine and to determine the LImetanephrine threshold in AVS.
Design and method: This retrospective study conducted at the HEGP ESH excellence center included 245 patients who had 1) AVS with simultaneous adrenal and peripheral vein samplings without cosyntropin stimulation between 07/2013 and 05/2017, 2) adrenal and peripheral vein samples stored at −80 °C to measure retrospectively free metanephrine. Receiver operating characteristic (ROC) curves were used to assess the performance of SImetanephrine and LImetanephrine.
Results: Based on SIcortisol and LIcortisol, 198/245 patients had successful AVS (SIcortisol above 2) among whom 108 had APA (LIcortisol above 4) and 90 BAH (LIcortisol below 4). 48/245 patients had failed AVS. Among the 245 AVS, 434 adrenal samples had SIcortisol ≥ 2. A SImetanephrine of 16 was the optimal threshold for successful AVS. This cutoff confirms the selectivity of 22 AVS among the 48 considered as non-selective with SIcortisol. 65 patients underwent unilateral adrenalectomy with a 6-month follow up confirming PA biochemical cure (PASO criteria). ROC curve analysis of LImetanephrine plotted APA (n=65) versus BAH (n=52) (AUC =0.954). There was a large overlap of LImetanephrine between APA and BAH. A threshold of LI< 2.5 confirmed BAH (100% specificity) while a threshold LI > 10 confirmed APA (100% specificity). A LImetanephrine threshold of 5 had 80% sensitivity and 95% specificity to distinguish between APA from BAH.
Conclusion: We confirmed that SImetanephrine is superior to SIcortisol in assessing the selectivity of AVS. A threshold of 16 for SImetanephrine decreased the rate of AVS falsely considered as failed. In contrast, LImetanephrine did not have enough sensitivity/specificity to distinguish between APA and BAH. The lack of a gold standard to confirm BAH may participate in this finding. A prospective study would be needed.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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