Mass Spectrometric Measurements of 11-Deoxycortisol, Androstenedione and Dehydroepiandrosterone Are Superior to Cortisol to Assess Selectivity of Non-Stimulated Adrenal Vein Sampling

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Objective: Successful adrenal venous sampling (AVS) is traditionally assessed using the ratio of cortisol in adrenal to peripheral venous plasma to calculate the selectivity index. With mass spectrometry other steroids can be simultaneously measured that may improve numbers of apparent successful sampling procedures. Design: Cross-sectional multicenter study. Patients: The study involved 229 patients who underwent unstimulated AVS for subtyping primary aldosteronism. Measurements: Adrenal and peripheral venous plasma cortisol, 11-deoxycortisol, androstenedione and dehydroepiandrosterone were measured by mass spectrometry to assess AVS selectivity. Ratios of aldosterone, measured by mass spectrometry, to each of the four steroids in right versus left adrenal venous plasma were used to assess lateralisation. Conclusions: 11-Deoxycortisol, androstenedione and dehydroepiandrosterone are more suitable biomarkers than cortisol to assess AVS selectivity and allow rescue of many procedures otherwise deemed unsuccessful. Measurements of cortisol to assess AVS selectivity are best replaced by mass spectrometric measurements of other steroids.

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