Measurement of 18-hydroxycorticosterone during adrenal vein sampling for primary aldosteronism
Abstract
CONTEXT: In primary aldosteronism, elevated serum 18-hydroxycorticosterone (18OHB) suggests aldosterone-producing adenoma (APA) rather than bilateral, idiopathic hyperaldosteronism (IHA), but little is known about the relative production of 18OHB and aldosterone (A) in APAs compared with IHA. OBJECTIVES: We measured 18OHB, A, and cortisol (F) in blood from adrenal vein sampling (AVS) studies. We compared the discriminatory power of gradients in 18OHB/A and 18OHB/F ratios with A/F ratio gradients for distinguishing APA from IHA. DESIGN, SETTING, AND SUBJECTS: We measured 18OHB and A in excess serum from 23 AVS studies performed at our university hospitals. MAIN OUTCOME MEASURES: We calculated the ratios 18OHB/A, 18OHB/F, and A/F for all specimens, and determined the adrenal vein gradients for these ratios. RESULTS: The 18OHB/A ratios were much lower in blood draining APAs (2.17 +/- 0.62) than in blood draining the contralateral adrenals (12.96 +/- 12.76; P < 0.001) but similar to blood draining IHA adrenals (4.69 +/- 4.32; P = 0.02). In contrast, the 18OHB/F ratios were elevated in specimens from APAs (26.03 +/- 11.51) compared with IHA adrenals (9.22 +/- 5.18; P < 0.001) or the contralateral adrenals (6.23 +/- 2.97; P < 0.001). Using 18OHB/F gradient greater than two or 18OHB/A gradient less than 0.5 as criteria for lateralization, interpretations agreed with lateralizations based on A/F gradients in 21 of 23 cases. CONCLUSIONS: High serum 18OHB in APA reflects augmented production of both 18OHB and A, not disproportionate 18OHB secretion relative to A. The 18OHB/A and 18OHB/F gradients are useful adjuncts but not as reliable as A/F gradients for A lateralization during AVS.
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The weak 18-hydroxylase activity of P450c11β explains why an adrenal with suppressed P450c11AS expression continues to synthesize 18OH-corticosterone.
“The weak 18-hydroxylase activity of P450c11 (458) explains why an adrenal with suppressed P450c11AS expression continues to synthesize 18OH-corticosterone (459).”
From The Molecular Biology, Biochemistry, and Physiology of Human Steroidogenesis and Its Disorders (2011) · cites this paper as [459]
The Discussion proposes that minor CYP11B1 18-hydroxylase activity produces 18OH-corticosterone in the suppressed adrenal contralateral to an aldosterone-producing adenoma. But it presents this as a model under cosyntropin stimulation, rather than establishing the mechanism generally or directly documenting suppressed P450c11AS expression. (LLM, conf=0.82)
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- Authors
- Auchus, R. J., Chandler, D. W., Singeetham, S., Chokshi, N., Nwariaku, F. E., Dolmatch, B. L., Holt, S. A., Wians, F. H., Josephs, S. C., Trimmer, C. K., Lopera, J., Vongpatanasin, W., Nesbitt, S. D., Leonard, D., & Victor, R. G.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- Department of Endocrinology Laboratory (D.W.C.), Esoterix, Incorporated, Calabasas Hills, California 91301
- Corresponding author
- Auchus, Richard J.
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2007-07-01
- Volume
- 92
- Issue
- 7
- Pages
- 2648-2651
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2027962635
- Cited by
- 35
- References
- 23
- Citations by year
- 2023: 2 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 3 · 2014: 3 · 2013: 3 · 2012: 2
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5t35dk066141-10)
- National Institute of Diabetes and Digestive and Kidney Diseases (T35-DK066141)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- 18-hydroxycorticosterone, primary aldosteronism, aldosterone-producing adenoma, idiopathic hyperaldosteronism, adrenal vein sampling, aldosterone biosynthesis, cortisol
- MeSH terms
- Adrenal Glands, Humans, Hydrocortisone, Hyperaldosteronism, Pilot Projects, Retrospective Studies, Veins, 18-Hydroxycorticosterone, Reproducibility of Results, Biomarkers
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