Accurate Location of Catheter Tip With the Free-to-Total Metanephrine Ratio During Adrenal Vein Sampling

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2022 Mar 14

PMID 35282466

Authors

Foteini Christou

Edward Pivin

Alban Denys

Karim A Abid

Tobias Zingg

Maurice Matter

Antoinette Pechere-Bertschi

Marc Maillard

Eric Grouzmann

Gregoire Wuerzner

Affiliations

Soon will be listed here.

Abstract

Background: The selectivity index (SI) of cortisol is used to document correct catheter placement during adrenal vein sampling (AVS) in patients with primary aldosteronism (PA). We aimed to determine the cutoff values of the SIs based on cortisol, free metanephrine, and the free-to-total metanephrine ratio (FTMR) using an adapted AVS protocol in combination with CT.

Methods: Adults with PA and referred for AVS were recruited in two hypertension centers. The cortisol and free metanephrine-derived SIs were calculated as the concentration of the analyte in adrenal veins divided by the concentration of the analyte in the distal vena cava. The FTMR-derived SI was calculated as the concentration of free metanephrine in the adrenal vein divided by that of total metanephrine in the ipsilateral adrenal vein. The AVS was classified as an unequivocal radiological success (uAVS) if the tip of the catheter was seen in the adrenal vein. The SI cutoffs of each index marker were established using receiver operating characteristic curve analysis.

Results: Out of 125 enrolled patients, 65 patients had an uAVS. The SI cutoffs were 2.6 for cortisol, 10.0 for free metanephrine, 0.31 for the FTMR on the left side, and 2.5, 9.9, and 0.25 on the right side. Compared to free metanephrine and the FTMR, cortisol misclassified AVS as unsuccessful in 36.6% and 39.0% of the cases, respectively.

Conclusion: This study is the first to calculate the SIs of cortisol, free metanephrine, and the FTMR indices for the AVS procedure. It confirms that free metanephrine-based SIs are better than those based on cortisol.

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References

Savard S, Amar L, Plouin P, Steichen O . Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension. 2013; 62(2):331-6. DOI: 10.1161/HYPERTENSIONAHA.113.01060. View

Peng K, Liao H, Chan C, Lin W, Yang S, Tsai Y . Presence of Subclinical Hypercortisolism in Clinical Aldosterone-Producing Adenomas Predicts Lower Clinical Success. Hypertension. 2020; 76(5):1537-1544. DOI: 10.1161/HYPERTENSIONAHA.120.15328. View

Ceolotto G, Antonelli G, Caroccia B, Battistel M, Barbiero G, Plebani M . Comparison of Cortisol, Androstenedione and Metanephrines to Assess Selectivity and Lateralization of Adrenal Vein Sampling in Primary Aldosteronism. J Clin Med. 2021; 10(20). PMC: 8538328. DOI: 10.3390/jcm10204755. View

Eisenhofer G, Rundquist B, Aneman A, Friberg P, Dakak N, Kopin I . Regional release and removal of catecholamines and extraneuronal metabolism to metanephrines. J Clin Endocrinol Metab. 1995; 80(10):3009-17. DOI: 10.1210/jcem.80.10.7559889. View

Dekkers T, Prejbisz A, Schultze Kool L, Groenewoud H, Velema M, Spiering W . Adrenal vein sampling versus CT scan to determine treatment in primary aldosteronism: an outcome-based randomised diagnostic trial. Lancet Diabetes Endocrinol. 2016; 4(9):739-746. DOI: 10.1016/S2213-8587(16)30100-0. View

Hiraishi K, Yoshimoto T, Tsuchiya K, Minami I, Doi M, Izumiyama H . Clinicopathological features of primary aldosteronism associated with subclinical Cushing's syndrome. Endocr J. 2011; 58(7):543-51. DOI: 10.1507/endocrj.k10e-402. View

Fallo F, Bertello C, Tizzani D, Fassina A, Boulkroun S, Sonino N . Concurrent primary aldosteronism and subclinical cortisol hypersecretion: a prospective study. J Hypertens. 2011; 29(9):1773-7. DOI: 10.1097/HJH.0b013e32834937f3. View

Rossi G, Auchus R, Brown M, Lenders J, Naruse M, Plouin P . An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2013; 63(1):151-60. DOI: 10.1161/HYPERTENSIONAHA.113.02097. View

van der Linden P, Steichen O, Zinzindohoue F, Plouin P . Blood pressure and medication changes following adrenalectomy for unilateral primary aldosteronism: a follow-up study. J Hypertens. 2012; 30(4):761-9. DOI: 10.1097/HJH.0b013e328350225d. View

10.

Gordon R, Stowasser M, Tunny T, Klemm S, Rutherford J . High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol. 1994; 21(4):315-8. DOI: 10.1111/j.1440-1681.1994.tb02519.x. View

11.

Ceolotto G, Antonelli G, Maiolino G, Cesari M, Rossitto G, Bisogni V . Androstenedione and 17-α-Hydroxyprogesterone Are Better Indicators of Adrenal Vein Sampling Selectivity Than Cortisol. Hypertension. 2017; 70(2):342-346. DOI: 10.1161/HYPERTENSIONAHA.117.09415. View

12.

Kline G, Leung A, So B, Chin A, Harvey A, Pasieka J . Application of strict criteria in adrenal venous sampling increases the proportion of missed patients with unilateral disease who benefit from surgery for primary aldosteronism. J Hypertens. 2018; 36(6):1407-1413. DOI: 10.1097/HJH.0000000000001693. View

13.

Dekkers T, Deinum J, SchultzeKool L, Blondin D, Vonend O, Hermus A . Plasma metanephrine for assessing the selectivity of adrenal venous sampling. Hypertension. 2013; 62(6):1152-7. DOI: 10.1161/HYPERTENSIONAHA.113.01601. View

14.

Monticone S, Viola A, Rossato D, Veglio F, Reincke M, Gomez-Sanchez C . Adrenal vein sampling in primary aldosteronism: towards a standardised protocol. Lancet Diabetes Endocrinol. 2014; 3(4):296-303. DOI: 10.1016/S2213-8587(14)70069-5. View

15.

Rossi G, Rossitto G, Amar L, Azizi M, Riester A, Reincke M . Clinical Outcomes of 1625 Patients With Primary Aldosteronism Subtyped With Adrenal Vein Sampling. Hypertension. 2019; 74(4):800-808. DOI: 10.1161/HYPERTENSIONAHA.119.13463. View

16.

Sawka A, Young W, Thompson G, Grant C, Farley D, Leibson C . Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med. 2001; 135(4):258-61. DOI: 10.7326/0003-4819-135-4-200108210-00010. View

17.

Anderson Jr G, Blakeman N, Streeten D . The effect of age on prevalence of secondary forms of hypertension in 4429 consecutively referred patients. J Hypertens. 1994; 12(5):609-15. DOI: 10.1097/00004872-199405000-00015. View

18.

Funder J, Carey R, Mantero F, Murad M, Reincke M, Shibata H . The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016; 101(5):1889-916. DOI: 10.1210/jc.2015-4061. View

19.

Brown J, Siddiqui M, Calhoun D, Carey R, Hopkins P, Williams G . The Unrecognized Prevalence of Primary Aldosteronism: A Cross-sectional Study. Ann Intern Med. 2020; 173(1):10-20. PMC: 7459427. DOI: 10.7326/M20-0065. View

20.

Eisenhofer G, Aneman A, Hooper D, Rundqvist B, Friberg P . Mesenteric organ production, hepatic metabolism, and renal elimination of norepinephrine and its metabolites in humans. J Neurochem. 1996; 66(4):1565-73. DOI: 10.1046/j.1471-4159.1996.66041565.x. View