18-Hydroxycorticosterone, 18-Hydroxycortisol, and 18-Oxocortisol in the Diagnosis of Primary Aldosteronism and Its Subtypes
18-Hydroxycorticosterone, 18-Hydroxycortisol, and 18-Oxocortisol in the Diagnosis of Primary Aldosteronism and Its Subtypes
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DOI：
10.1210/jc.2011-2384
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发表时间：
2012-03-01
影响因子：
5.8
通讯作者：
Veglio, Franco
中科院分区：
文献类型：
--
作者：
Mulatero, Paolo;di Cella, Stefania Morra;Veglio, Franco
背景：原发性醛固酮增多症 (PA) 的诊断是通过筛查、确认测试和亚型诊断（计算机断层扫描和肾上腺静脉采样）进行的。然而，一些检测费用昂贵且大多数医院无法进行。 目的：本研究的目的是评估血清 18-羟基皮质酮 (s18OHB)、尿液和血清 18-羟基皮质醇（u- 和 s18OHF）以及尿液和血清 18-氧化皮质醇（u- 和 s18oxoF）在诊断 PA 及其亚型、醛固酮腺瘤 (APA) 中的作用患者：该研究包括 62 名低肾素原发性高血压 (EH) 患者、81 名 PA 患者（20 APA、61 BAH）、24 名糖皮质激素可治愈的醛固酮增多症患者、16 名肾上腺偶发瘤患者和 30 名血压正常的患者。 干预和主要结果指标：我们测量了 s18OHB、盐水负荷试验（SLT）前后以及 24 小时 u18OHF 和 u18oxoF 的 s18OHF 和 s18oxoF。结果：与 EH 和正常受试者相比，PA 患者表现出显着更高的 s18OHB、u18OHF 和 u18oxoF 水平； APA 患者的 s18OHB、u18OHF 和 u18oxoF 水平显着高于 BAH 患者。 s18OHF 和 s18oxoF 获得了类似的结果。 SLT 显着减少所有组中的 s18OHB、s18OHF 和 s18oxoF，但与 BAH 和 EH 相比，APA 患者的类固醇减少要少得多。 EH 患者 SLT 后 s18OHB/醛固酮比值增加了一倍多，但 APA 患者保持不变。结论：醛固酮/血浆肾素活性比值阳性患者的 u18OHF、u18oxoF 和 s18OHB 测量值与 PA 患者的验证性测试和肾上腺静脉采样相关。如果得到验证，这些类固醇检测将完善 PA 的诊断检查。 (临床内分泌代谢杂志 97: 881-889, 2012)
Context: Diagnosis of primary aldosteronism (PA) is made by screening, confirmation testing, and subtype diagnosis (computed tomography scan and adrenal vein sampling). However, some tests are costly and unavailable in most hospitals.Objective: The aim of the study was to evaluate the role of serum 18-hydroxycorticosterone (s18OHB), urinary and serum 18-hydroxycortisol (u- and s18OHF), and urinary and serum 18-oxocortisol (u- and s18oxoF) in the diagnosis of PA and its subtypes, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH).Patients: The study included 62 patients with low-renin essential hypertension (EH), 81 patients with PA (20 APA, 61 BAH), 24 patients with glucocorticoid-remediable aldosteronism, 16 patients with adrenal incidentaloma, and 30 normotensives.Intervention and Main Outcome Measures: We measured s18OHB, s18OHF, and s18oxoF before and after saline load test (SLT) and 24-h u18OHF and u18oxoF.Results: PA patients displayed significantly higher levels of s18OHB, u18OHF, and u18oxoF compared to EH and normal subjects; APA patients displayed s18OHB, u18OHF, and u18oxoF levels significantly higher than BAH patients. Similar results were obtained for s18OHF and s18oxoF. SLT significantly reduced s18OHB, s18OHF, and s18oxoF in all groups, but steroid reduction was much less for APA patients compared to BAH and EH. The s18OHB/aldosterone ratio after SLT more than doubled in EH but remained unchanged in APA patients.Conclusions: u18OHF, u18oxoF, and s18OHB measurements in patients with a positive aldosterone/plasma renin activity ratio correlate with confirmatory tests and adrenal vein sampling in PA patients. If verified, these steroid assays would refine the diagnostic workup for PA. (J Clin Endocrinol Metab 97: 881-889, 2012)