Poster Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Utility of metanephrine measurement during adrenal vein sampling in patients with primary aldosteronism and abnormal dexamethasone suppression (#538)

Anna Y.N. Jiang 1 2 , Renata Libianto 1 2 , Jimmy Shen 1 2 , James Doery 3 4 , Zhong Lu 4 , Winston Chong 5 , Kenneth K. Lau 6 7 , Peter J. Fuller 1 2 , Jun Yang 1 2
  1. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
  2. Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
  3. Department of Medicine, Monash University, Clayton, Victoria, Australia
  4. Department of Pathology, Monash Health, Clayton, Victoria, Australia
  5. Radiology, Alfred Health, Melbourne, Victoria, Australia
  6. Monash Imaging, Monash Health, Clayton, Victoria, Australia
  7. Southern Clinical School, Faculty of Medicine, Monash University, Clayton, Victoria, Australia

Primary aldosteronism (PA) co-exists with autonomous cortisol production in 5-27% of patients. Adrenal vein sampling (AVS) is the current gold-standard for accurately differentiating between unilateral and bilateral adrenal aldosterone excess. Adrenal vein (AV) cortisol is typically measured to normalise the aldosterone concentration relative to the catheter position in the AV. Therefore, in patients with concurrent autonomous cortisol secretion, there is the potential to mis-interpret cannulation success and lateralisation outcomes. This would ultimately misinform management decisions.

Our objective was to understand the utility of plasma metanephrine and normetanephrine concentrations in the assessment of cannulation success and lateralisation in comparison with cortisol in patients with PA and concurrent abnormal dexamethasone suppression undergoing AVS.

In this retrospective case series, ten consecutive patients with PA and an abnormal 1mg overnight dexamethasone suppression test had plasma metanephrine and normetanephrine measured in addition to aldosterone and cortisol concentrations during AVS. Cannulation success and lateralisation were calculated based on these hormones. Patients underwent either surgery or medical management and were followed-up longitudinally using biochemical and clinical markers of aldosterone and cortisol excess.

AV cannulation success as determined by metanephrine was higher than that determined by cortisol (right AV 100% compared to 80%; left AV 88.9% compared to 85% respectively). Aldosterone lateralisation as determined by either the aldosterone-to-cortisol or aldosterone-to-metanephrine (or normetanephrine) ratio was concordant in seven of ten patients. Based on post-operative outcomes in five patients, metanephrine and normetanephrine are comparable, and in one case superior, to cortisol for the assessment of lateralisation.

In conclusion, metanephrine and normetanephrine assessment during AVS may aid clinical decision making in patients with PA and abnormal dexamethasone suppression.

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