EP100 - ECE_2028 - Apparent bilateral aldosterone suppression during non-stimulated adrenal vein sampling: an artifact of the Liaison immunoassay and other causes

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Abstract Objective Subtyping of primary aldosteronism usually requires adrenal vein sampling (AVS). Interpretation can be compromised by apparent bilateral aldosterone suppression (ABAS), which we hypothesized reflects an artifact of the Liaison immunoassay of aldosterone. We therefore compared measurements of aldosterone by liquid chromatography-tandem mass spectrometry (LC-MS/MS) with measurements by the Liaison immunoassay and a different immunoassay. Design retrospective cross-sectional multicenter study. Patients The study involved 222 patients who underwent bilaterally selective non-stimulated AVS. Measurements Adrenal and peripheral venous plasma aldosterone concentrations were measured by Liaison and iSYS immunoassays in 112 and 110 respective samplings compared to LC-MS/MS in all samplings. Ratios of aldosterone to cortisol below 1.0 in adrenal versus peripheral vein samples defined suppression of aldosterone secretion. Results Among all AVS procedures, 9.5% (21/222) of samplings with immunoassay measurements showed ABAS, 3-fold more (P = .0004) than the 3.2% (7/222) with LC-MS/MS measurements. Rates of ABAS were particularly high with the Liaison immunoassay compared to LC-MS/MS (14.2% vs 0.9%, P < .0001) and remained higher after substitution of LC-MS/MS measurements of cortisol in the ratio with immunoassay measured aldosterone (9.8% vs 0.9%, P = .0064). Among 110 procedures involving iSYS immunoassay measurements, rates of ABAS at 4.6% were a third (P = .0132) those of the Liaison immunoassay and did not differ from LC-MS/MS measurements (5.5%). ABAS confined to LC-MS/MS measurements in one patient was resolved with a second right adrenal vein sampling. Conclusions ABAS occurs more frequently using the Liaison immunoassay of aldosterone than the iSYS immunoassay and LC/MS-MS measurement. In addition to this artefact, ABAS can also reflect adrenal vein catheter placement.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.