Abstract
We hypothesized aldosteronoma responsiveness to cosyntropin may be a characterizing feature that could be determined in addition to standard adrenal vein sampling (AVS) data. We reviewed an AVS database from June 2005 to October 2011 including 65 patients with confirmed primary aldosteronism (PA) who underwent AVS and, if applicable, unilateral adrenalectomy. Patients were divided into confirmed lateralized and non-lateralized groups and subgrouped by histology. Plasma aldosterone in inferior vena cava (IVC) pre- and post-cosyntropin infusion during AVS was measured. Peak aldosterone and proportional change was compared between groups. Baseline and peak IVC aldosterone was higher in lateralized patients but incremental aldosterone rise was much greater in subjects with bilateral hyperplasia. From receiver operator characteristics (ROC) analysis, the optimized diagnostic cut point of peak IVC aldosterone of >649 pmol l−1 would have a sensitivity of 94% for surgical disease although specificity of just 59%. A 250% increase in IVC aldosterone following cosyntropin would be specific enough to exclude 87% of surgical/lateralized disease. These diagnostic capabilities are similar to other results with non-AVS tests performed for diagnosis of lateralization. Although not specific enough to replace standard AVS interpretation, a marked IVC aldosterone increase after cosyntropin during AVS is a useful additional test to diagnose non-lateralizing forms of PA. Such a calculation requires no additional expense or tests.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Mulatero P, Stowasser M, Loh K, Fardella CE, Gordon RD, Mosso L et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004; 89: 1045–1050.
Nishikawa T, Saito J, Omura M . Prevalence of primary aldosteronism: should we screen for primary aldosteronism before treating hypertensive patients with medication? Endocrine J 2007; 54: 487–495.
Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C et al. A prospective study of the prevalence of primary aldsteronism in 1125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293–2300.
Tresallet CT, Salepcioglu H, Godiris-Petit G, Hoang C, Girerd X, Menegaux F . Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology. Surgery 2010; 148: 129–134.
Hennings J, Andreasson S, Botling J, Hagg A, Sundin A, Hellman P . Longterm effects of surgical corrections of adrenal hyperplasia and adenoma causing primary aldosteronism. Langenbecks Arch Surg 2010; 395: 133–137.
Graham UM, Ellist PK, Hunter SJ, Leslie H, Mullan KR, Atkinson AB . cases of primary aldosteronism: careful choice of patients for surgery using adrenal venous sampling and CT imaging results in excellent blood pressure and potassium outcomes. Clin Endocrinology 2012; 76: 26–32.
Waldman J, Maurer L, Holler J, Kann PH, Ramaswamy A, Bartsch DK et al. Outcome of surgery for primary hyperaldosteronism. World J Surg 2011; 35: 2422–2427.
Ishidoya S, Kaiho Y, Ito A, Morimoto R, Satoh F, Ito S et al. Single center outcome of laparoscopic unilateral adrenalectomy for patients with primary aldosteronism: lateralizing disease using results of adrenal venous sampling. Urology 2011; 78: 68–73.
Letavernier E, Peyrard S, Amar L, Zinzindohoue F, Fiquet B, Plouin PF . Blood pressure outcome of adrenalectomy in patients with primary hyperaldosteronism with or without unilateral adenoma. J Hypertens 2008; 26: 1816–1823.
Magill SB, Raff H, Shaker JL, Brickner RC, Knechtges TE, Kehoe ME et al. Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab 2001; 86: 1066–1071.
Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M et al. Case detection, diagnosis and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93: 3266–3281.
Rossi GP, Barisa M, Allolio B, Auchus RJ, Amar L, Cohen D et al. The adrenal vein sampling international study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab 2012; 97: 1606–1614.
Rossi GP . New concepts in adrenal vein sampling for aldosterone in the diagnosis of primary aldosteronism. Curr Hypertens Rep 2007; 9: 90–97.
Mulatero P, Bertello C, Sukor N, Gordon R, Rossato D, Daunt N et al. Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism. Hypertension 2010; 55: 667–673.
Rossi GP, Pitter G, Bernante P, Motta R, Feltrin G, Miotto D . Adrenal vein sampling for primary aldosteronism: the assessment of selectivity and lateralization of aldosterone excess baseline and after adrenocorticotropic hormone (ACTH) stimulation. J Hypertens 2008; 26: 989–997.
Kline GA, Harvey A, Jones C, Hill MD, So B, Scott-Douglas N et al. Adrenal vein sampling in primary aldosteronism: final diagnosis depends upon which interpretation rule is used. Int Urol Nephrol 2008; 40: 1035–1043.
Burton TJ, Mackenzie IS, Balan K, Koo B, Bird N, Soloviev DV et al. Evaluation of the sensitivity and specificity of 11C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by conn’s adenomas. J Clin Endocrinol Metab 2012; 97: 100–109.
Mulatero P, Morra di Cella S, Monticone S, Schiavone D, Manzo M, Mengozzi G et al. 18-Hydroxycorticosterone, 18-hydroxycortisol, and 18-oxocortisol in the diagnosis of primary aldosteronism and its subtypes. J Clin Endocrinol Metab 2012; 97: 881–889.
Litchfield WR, New MI, Coolidge C, Lifton RP, Dluhy RG . Evaluation of the dexamethasone suppression test for the diagnosis of glucocorticoid-remediable aldosteronism. J Clin Endocrinol Metab 1997; 82 (11): 3570–3573.
Mulatero P, Bertello C, Rossato D, Mengozzi G, Milan A, Garrone C et al. Roles of clinical criteria, computed tomography scan and adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes. J Clin Endocrinol Metab 2008; 93: 1366–1371.
Alvarez-Madrazo S, Padmanabhan S, Mavosi BM, Watkins H, Avery P, Wallace AM et al. Familial and phenotypic associations of the aldosterone-renin ratio. J Clin Endocrinol Metab 2009; 94 (11): 4324–4333.
Montori VM, Young WF . Use of plasma aldosterone concentration to plasma renin activity ratio as a screening test for primary aldosteronism. A systematic review of the literature. Endocrinol Metab Clin N Am 2002; 31: 619–632.
Lau JHG, Candy Sze WC, Reznek RH, Matson M, Sahdav A, Carpenter R et al. A prospective evaluation of postural stimulation testing, computed tomography and adrenal vein sampling in the differential diagnosis of primary aldosteronism. Clin Endocrinol 2012; 76: 182–188.
Nakamura Y, Satoh F, Morimoto R, Kudo M, Takase K, Gomez-Sanchez CE et al. 18-Oxocortisol measurement in adrenal vein sampling as a biomarker for subclassifying primary aldosteronism. J Clin Endocrinol Metab 2011; 96: E1271–E1278.
Kupers EM, Amar L, Raynaud A, Plouin PF, Steichen O . A clinical prediction score to diagnose unilateral primary aldosteronism. J Clin Endocrinol Metab 2012; 97 (10): 3530–3537.
Sonoyama T, Sone M, Miyashita K, Tamura N, Yamahara K, Park K et al. Significance of adrenocorticotropin stimulation test in the diagnosis of an aldosterone producing adenoma. J Clin Endocrinol Metab 2011; 96: 2771–2778.
Dluhy RG, Lifton RP . Glucocorticoid remediable aldosteronism. J Clin Endocrinol Metab 1999; 84: 4341–4344.
Pizzolo F, Trabetti E, Guarini P, Mulatero P, Ciacciarelli A, Blengio GS et al. Glucocorticoid remediable aldosteronism (GRA) screening in hypertensive patients from a primary care setting. J Hum Hypertens 2005; 19: 325–327.
Mulatero P, Tizzani D, Viola A, Bertello C, Monitcone S, Mengozzi G et al. Prevalence and characteristics of familial hyperaldosteronism. Hypertension 2011; 58: 797–803.
Honour JW, Bridges NA, Conway-Phillips E, Hindmarsh PC . Plasma aldosterone response to the low dose adrenocorticotropin (ACTH 1-24) stimulation test. Clin Endocrinol 2007; 68: 299–303.
Zwermann O, Suttmann Y, Bidlingmaier M, Beuschlein F, Reincke M . Screening for membrane hormone receptor expression in primary aldosteronism. Eur J Endocrinol 2009; 160: 443–451.
Ye P, Mariniello B, Mantero F, Rainey WE . G-protein coupled receptors in aldosterone producing adenoma: a potential cause of hyperaldosteronism. J Endocrinol 2007; 195: 39–48.
Lampron A, Bourdeau I, Oble S, Godbout A, Schurch W, Arjane P et al. Regulation of aldosterone secretion by several aberrant receptors including for glucose dependent insulinotropic peptide in a patient with an aldosteronoma. J Clin Endocrinol Metab 2009; 94: 750–756.
Ehrhart-Bornstein M, Lamounier-Zepter V, Schraven A, Langenbach J, Willenberg HS, Barthel A et al. Human adipocytes secrete mineralocorticoid releasing factors. Proc Natl Acad Sci USA 2003; 100: 14211–14216.
Goodfried TL, Ball DL, Raff H, Bruder ED, Gardner HW, Spiteller G . Oxidized products of linoleic acid stimulate adrenal steroidogenesis. Endocr Res 2002; 28: 325–330.
Sonino N, Tomba E, Genesia ML, Bertello C, Mulatero P, Veglio F et al. Psychological assessment of primary aldosteronism: a controlled study. J Clin Endocrinol Metab 2011; 96: E878–E883.
Kubzansky LD, Adler GK . Aldosterone: a forgotten mediator of the relationship between psychological stress and heart disease. Neurosci Biobehav R 2010; 34: 80–86.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Kline, G., Pasieka, J., Harvey, A. et al. A marked proportional rise in IVC aldosterone following cosyntropin administration during AVS is a signal to the presence of adrenal hyperplasia in primary aldosteronism. J Hum Hypertens 28, 298–302 (2014). https://doi.org/10.1038/jhh.2013.116
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/jhh.2013.116
Keywords
This article is cited by
-
Subtype prediction of primary aldosteronism by combining aldosterone concentrations in the left adrenal vein and inferior vena cava: a multicenter collaborative study on adrenal venous sampling
Journal of Human Hypertension (2018)
-
Aldosterone Excess and Resistant Hypertension: Investigation and Treatment
Current Hypertension Reports (2014)