The utility of plasma metanephrines to optimise adrenal vein sampling for primary aldosteronism: a single centre experience
Author(s)
Type
Journal Article
Abstract
Background
Primary aldosteronism (PA) is a prevalent yet frequently underdiagnosed cause of secondary hypertension, affecting up to 10% of hypertensive individuals and contributing to increased cardiovascular risk. Accurate diagnosis is vital, as unilateral PA cases typically require surgical intervention, while bilateral disease is managed medically. Adrenal vein sampling (AVS) remains the gold standard for diagnosing subtypes of PA; however, the use of cortisol to confirm accuracy of cannulation poses challenges due to its long half-life and potential cortisol co-secretion by aldosterone-producing adenomas.
Objective
This study evaluates the diagnostic utility of plasma metanephrines (MN) as an alternative to cortisol in assessing cannulation success and lateralisation of aldosterone secretion.
Methods
Analysing 132 unstimulated AVS procedures performed by a single operator on 129 patients with confirmed PA, we established optimal cut-off values for the selectivity index (SI) and lateralisation index (LI) using MN.
Results
A MN SI cut-off of >3 achieved 99% sensitivity and 100% specificity, while an aldosterone/MN LI of >4 indicated unilateral disease with 94% sensitivity and 96% specificity.
Conclusion
Our findings demonstrate that incorporating MN measurements significantly enhances the accuracy of AVS interpretations, particularly in cases of cortisol co-secretion, thereby minimising diagnostic errors and optimising treatment strategies. This study supports the use of MN as reliable analytes to improve the diagnostic accuracy of AVS.
Primary aldosteronism (PA) is a prevalent yet frequently underdiagnosed cause of secondary hypertension, affecting up to 10% of hypertensive individuals and contributing to increased cardiovascular risk. Accurate diagnosis is vital, as unilateral PA cases typically require surgical intervention, while bilateral disease is managed medically. Adrenal vein sampling (AVS) remains the gold standard for diagnosing subtypes of PA; however, the use of cortisol to confirm accuracy of cannulation poses challenges due to its long half-life and potential cortisol co-secretion by aldosterone-producing adenomas.
Objective
This study evaluates the diagnostic utility of plasma metanephrines (MN) as an alternative to cortisol in assessing cannulation success and lateralisation of aldosterone secretion.
Methods
Analysing 132 unstimulated AVS procedures performed by a single operator on 129 patients with confirmed PA, we established optimal cut-off values for the selectivity index (SI) and lateralisation index (LI) using MN.
Results
A MN SI cut-off of >3 achieved 99% sensitivity and 100% specificity, while an aldosterone/MN LI of >4 indicated unilateral disease with 94% sensitivity and 96% specificity.
Conclusion
Our findings demonstrate that incorporating MN measurements significantly enhances the accuracy of AVS interpretations, particularly in cases of cortisol co-secretion, thereby minimising diagnostic errors and optimising treatment strategies. This study supports the use of MN as reliable analytes to improve the diagnostic accuracy of AVS.
Date Issued
2025-09-01
Date Acceptance
2025-05-10
Citation
Clinical Endocrinology, 2025, 103 (3), pp.294-302
ISSN
0300-0664
Publisher
Wiley
Start Page
294
End Page
302
Journal / Book Title
Clinical Endocrinology
Volume
103
Issue
3
Copyright Statement
© 2025 The Author(s). Clinical Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40386887
Subjects
adrenal vein sampling
cannulation success
CONSENSUS
DIAGNOSIS
Endocrinology & Metabolism
lateralisation
Life Sciences & Biomedicine
mild autonomous cortisol secretion
plasma metanephrines
Science & Technology
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2025-05-19