Resolution of paradoxical bilateral aldosterone suppression with mass spectrometry
2
Issued Date
2025-04-01
Resource Type
ISSN
08044643
eISSN
1479683X
Scopus ID
2-s2.0-105004229656
Pubmed ID
40233185
Journal Title
European Journal of Endocrinology
Volume
192
Issue
4
Start Page
511
End Page
518
Rights Holder(s)
SCOPUS
Bibliographic Citation
European Journal of Endocrinology Vol.192 No.4 (2025) , 511-518
Suggested Citation
Wannachalee T., Vibhatavata P., Konzen S., Lee C., Gherasim C., Shields J.J., Turcu A.F. Resolution of paradoxical bilateral aldosterone suppression with mass spectrometry. European Journal of Endocrinology Vol.192 No.4 (2025) , 511-518. 518. doi:10.1093/ejendo/lvaf079 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110030
Title
Resolution of paradoxical bilateral aldosterone suppression with mass spectrometry
Corresponding Author(s)
Other Contributor(s)
Abstract
Objective: Adrenal vein sampling (AVS) is the standard-of-care for primary aldosteronism (PA) subtyping. Paradoxical bilateral aldosterone suppression (BAS), defined by lower aldosterone/cortisol ratio in both adrenal veins compared to peripheral circulation, has been reported in AVS studies, but the underlying causes remain poorly understood. We aimed to assess the prevalence of BAS in AVS without and with cosyntropin stimulation based on clinical immunoassays, and to probe the BAS results using liquid chromatography mass spectrometry (LC-MS/MS). Methods: We retrospectively assessed the BAS prevalence among patients with confirmed PA who underwent AVS in a referral center between 2015 and 2023. Simultaneous AVS was performed both before and after cosyntropin stimulation. LC-MS/MS quantitation of cortisol and aldosterone was performed in patients with serum available. Results: Of 402 patients, BAS was observed in 102 (25%): Pre-cosyntropin in 31, post-cosyntropin in 48 (including 10 who did not meet successful catheterization criteria in baseline samples), and both pre- and post- cosyntropin in 23. Paradoxically, AVS indicated lateralized PA in 36% and 43% of patients with BAS based on pre- and post-cosyntropin data, respectively. Using LC-MS/MS, BAS was not present in 42/53 (79%) patients with serum available. Compared to LC-MS/MS, immunoassays overestimated cortisol across the analytical range. In contrast, for aldosterone, immunoassays overestimated low concentrations, but underestimated high concentrations, such as those measured in adrenal veins. Conclusions: Apparent BAS derives primarily from artifacts in clinical immunoassays. These data caution against assuming that aldosterone suppression indicates contralateral aldosterone lateralization in cases with partial adrenal vein catheterization failure.