Adrenal Vein Catecholamine Levels and Ratios: Reference Intervals Derived from Patients with Primary Aldosteronism

Candy W.C. Sze; Samuel Matthew O’Toole; Roger Kent Tirador; Scott A. Akker; Matthew Matson; Leslie Perry; Maralyn Rose Druce; Tanja Dekkers; Jaap Deinum; Jacques W.M. Lenders; Graeme Eisenhofer; William Martyn Drake

doi:10.1055/s-0042-124419

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2017; 49(06): 418-423
DOI: 10.1055/s-0042-124419

Endocrine Care

Adrenal Vein Catecholamine Levels and Ratios: Reference Intervals Derived from Patients with Primary Aldosteronism

Candy W.C. Sze^*

¹Department of Endocrinology, St Bartholomew’s Hospital, London, UK

,

Samuel Matthew O’Toole^*

¹Department of Endocrinology, St Bartholomew’s Hospital, London, UK

,

Roger Kent Tirador

¹Department of Endocrinology, St Bartholomew’s Hospital, London, UK

,

Scott A. Akker

¹Department of Endocrinology, St Bartholomew’s Hospital, London, UK

,

Matthew Matson

²Department of Radiology, St Bartholomew’s Hospital, London, UK

,

Leslie Perry

³Department of Biochemistry, St Bartholomew’s Hospital, London, UK

,

Maralyn Rose Druce

¹Department of Endocrinology, St Bartholomew’s Hospital, London, UK

,

Tanja Dekkers

⁴Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

,

Jaap Deinum

⁴Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

,

Jacques W.M. Lenders

⁴Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

⁵Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

,

Graeme Eisenhofer

⁵Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

⁶Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

,

William Martyn Drake

¹Department of Endocrinology, St Bartholomew’s Hospital, London, UK

› Author Affiliations

Abstract

Phaeochromocytoma localisation is generally reliably achieved with modern imaging techniques, particularly in sporadic cases. On occasion, however, there can be diagnostic doubt due to the presence of bilateral adrenal abnormalities, particularly in patients with mutations in genes predisposing them to the development of multiple phaeochromocytomas. In such cases, surgical intervention is ideally limited to large or functional lesions due to the long-term consequences associated with hypoadrenalism. Adrenal venous sampling (AVS) for catecholamines has been used in this situation to guide surgery, although there are few data available to support diagnostic thresholds. Retrospective analyses of AVS results from 2 centres were carried out. A total of 172 patients (88 men, 84 women) underwent AVS under cosyntropin stimulation for the diagnosis of established primary aldosteronism (PA) with measurement of adrenal and peripheral venous cortisol, aldosterone and catecholamines. Six patients (3 men, 3 women) with phaeochromocytoma underwent AVS for diagnostic purposes with subsequent histological confirmation. Reference intervals for the adrenal venous norepinephrine to epinephrine ratio were created from the PA group. Using the 97.5th centile (1.21 on the left, 1.04 on the right), the false negative rate in the phaeochromocytoma group was 0%. In conclusion, this study describes the largest dataset of adrenal venous catecholamine measurements and provides reference intervals in patients without phaeochromocytoma. This strengthens the certainty with which conclusions related to adrenal venous sampling for catecholamines can be drawn, acknowledging the procedure is not part of the routine diagnostic workup and is an adjunct for use only in difficult clinical cases.

Key words

adrenal venous sampling - catecholamines - phaeochromocytoma - hypertension - reference interval

Full Text

References

References
1 Khorram-Manesh A, Ahlman H, Nilsson O, Odén A, Jansson S. Mortality associated with pheochromocytoma in a large Swedish cohort. Eur J Surg Oncol 2004; 30: 556-559
2 Zelinka T, Petrák O, Turková H, Holaj R, Strauch B, Kršek M, Vránková AB, Musil Z, Dušková J, Kubinyi J, Michalský D, Novák K, Widimský J. High incidence of cardiovascular complications in pheochromocytoma. Horm Metab Res 2012; 44: 379-384
3 JWM Lenders, Duh Q-Y, Eisenhofer G, Gimenez-Roqueplo A-P, Grebe SKG, Murad MH, Naruse M, Pacak K, Young WF. Pheochromocytoma and paraganglioma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99: 1915-1942
4 Maher ER, Neumann HP, Richard S. von Hippel-Lindau disease: a clinical and scientific review. Eur J Hum Genet 2011; 19: 617-623
5 Brandi ML, Gagel RF, Angeli A, Bilezikian JP, Beck-Peccoz P, Bordi C, Conte-Devolx B, Falchetti A, Gheri RG, Libroia A, Lips CJ, Lombardi G, Mannelli M, Pacini F, Ponder BA, Raue F, Skogseid B, Tamburrano G, Thakker RV, Thompson NW, Tomassetti P, Tonelli F, Wells SA, Marx SJ. Guidelines for diagnosis and therapy of MEN type 1 and type 2. J Clin Endocrinol Metab 2001; 86: 5658-5671
6 Jasperson KW, Kohlmann W, Gammon A, Slack H, Buchmann L, Hunt J, Kirchhoff AC, Baskin H, Shaaban A, Schiffman JD. Role of rapid sequence whole-body MRI screening in SDH-associated hereditary paraganglioma families. Fam Cancer 2014; 13: 257-265
7 Von Euler US, Gemzell CA, Strom G, Westman A. Report of a case of pheochromocytoma, with special regard to preoperative diagnostic problems. Acta Med Scand 1955; 153: 127-136
8 Crout JR, Sjoerdsma A. Catecholamines in the localization of pheochromocytoma. Circulation 1960; 22: 516-525
9 Fleisher DS, Voci G, Cresson SL, Karafin L. Preoperative localization of pheochromocytoma. J Pediatr 1964; 64: 711-715
10 Grim CE, Glenn JF, Wynn JO, Gunnells JC. Bilateral pheochromocytoma: the application of a plasma catecholamine bioassay for tumor localization. Am Heart J 1967; 74: 809-815
11 Davies RA, Patt NL, Sole MJ. Localization of pheochromocytoma by selective venous catheterization and assay of plasma catecholamines. Can Med Assoc J 1979; 120: 539-542
12 Jones DH, Allison DJ, Hamilton CA, Reid JL. Selective venous sampling in the diagnosis and localization of phaeochromocytoma. Clin Endocrinol (Oxf) 1979; 10: 179-186
13 Moss S, Greenbaum R, Sever PS. Preoperative localization of a phaeochromocytoma using plasma noradrenaline concentrations in multiple-site samples. J R Soc Med 1980; 73: 139-141
14 Palublnskas J, Roizen MF, Conte FA. Localization of functioning pheochromocytomas by venous sampling and radioenzymatic analysis. Radiology 1980; 136: 495-496
15 Nobin A, Karp W, Lunderquist A, Rosengren E, Sandén G, Sundler F. Localization of carcinoids and pheochromocytomas with vein catheterization and amine determination. Brain Res Bull 1982; 9: 781-797
16 Allison DJ, Brown MJ, Jones DH, Timmis JB. Role of venous sampling in locating a phaeochromocytoma. Br Med J (Clin Res Ed) 1983; 286: 1122-1124
17 Miller JL, Immelman EJ, Roman TE, Mervis B. Phaeochromocytoma of the urinary bladder localized by selective venous sampling and computed tomography. Postgrad Med J 1983; 59: 533-535
18 Bomanji J, Bouloux PMG, Levison DA, Flatman WD, Horne T, Britton KE, Ross G, Besser GM. Observations on the function of normal adrenomedullary tissue in patients with phaeochromocytomas and other paragangliomas. Eur J Nucl Med 1987; 13: 86-89
19 Cockcroft JR, Ritter JM, Allison DJ, Causon R, Brown MJ. Location of extra-adrenal catecholamine secreting tumours by selective venous sampling and nuclear magnetic resonance scanning. Postgrad Med J 1987; 63: 451-453
20 Newbould EC, Ross GA, Dacie JE, Bouloux PM, Besser GM, Grossman A. The use of venous catheterization in the diagnosis and localization of bilateral phaeochromocytomas. Clin Endocrinol (Oxf) 1991; 35: 55-59
21 Chew SL, Dacie JE, Reznek RH, Newbould EC, Sheaves R, Trainer PJ, Lowe DG, Shand WS, Hungerford J, Besser GM. Bilateral phaeochromocytomas in von Hippel-Lindau disease: diagnosis by adrenal vein sampling and catecholamine assay. Q J Med 1994; 87: 49-54
22 Pacak K, Goldstein DS, Doppman JL, Shulkin BL, Udelsman R, Eisenhofer G. A “Pheo” lurks: Novel approaches for locating occult pheochromocytoma. J Clin Endocrinol Metab 2001; 86: 3641-3646
23 Srirangalingam U, Khoo B, Matson M, Carpenter R, Reznek R, Maher ER, Chew SL, Drake WM. SDHD-related chromaffin tumours: disease localisation to genetic dysfunction. Horm Res pædiatrics 2010; 73: 135-139
24 Därr R, Eisenhofer G, Kotzerke J, Zöphel K, Stroszczynski C, Deinum J, Schultze Kool LJ, Pistorius S, Neumann H, Bornstein SR, Hofbauer LC. Is there still a place for adrenal venous sampling in the diagnostic localization of pheochromocytoma?. Endocrine 2011; 40: 75-79
25 Mercado-Asis LB, Tingcungco AG, Bolong DT, Lopez Ra, Caguioa EV, Yamamoto ME, Marcos J, Mercado AB, Zacarias MB. Diagnosis of small adrenal pheochromocytomas by adrenal venous sampling with glucagon stimulation test. Int J Endocrinol Metab 2011; 9: 323-329
26 Freel EM, Stanson AW, Thompson GB, Grant CS, Farley DR, Richards ML, Young WF. Adrenal venous sampling for catecholamines: A normal value study. J Clin Endocrinol Metab 2010; 95: 1328-1332
27 Lau JHG, Sze WCC, Reznek RH, Matson M, Sahdev A, Carpenter R, Berney DM, Akker SA, Chew SL, Grossman AB, Monson JP, Drake WM. A prospective evaluation of postural stimulation testing, computed tomography and adrenal vein sampling in the differential diagnosis of primary aldosteronism. Clin Endocrinol (Oxf) 2012; 76: 182-188
28 Sze WCC, Soh LM, Lau JH, Reznek R, Sahdev A, Matson M, Riddoch F, Carpenter R, Berney D, Grossman AB, Chew SL, Akker SA, Druce MR, Waterhouse M, Monson JP, Drake WM. Diagnosing unilateral primary aldosteronism - comparison of a clinical prediction score, computed tomography and adrenal venous sampling. Clin Endocrinol (Oxf) 2014; 81: 25-30
29 Webb R, Mathur A, Chang R, Baid S, Nilubol N, Libutti SK, Stratakis CA, Kebebew E. What is the best criterion for the interpretation of adrenal vein sample results in patients with primary hyperaldosteronism?. Ann Surg Oncol 2012; 19: 1881-1886
30 Eisenhofer G, Goldstein DS, Stull R, Keiser HR, Sunderland T, Murphy DL, Kopin IJ. Simultaneous liquid-chromatographic determination of 3,4-dihydroxyphenylglycol, catecholamines, and 3,4-dihydroxyphenylalanine in plasma, and their responses to inhibition of monoamine oxidase. Clin Chem 1986; 32: 2030-2033
31 Wurtman RJ, Axelrod J. Adrenaline synthesis: control by the pituitary gland and adrenal glucocorticoids. Science 1965; 150: 1464-1465
32 Kahaly G, Krause U, Ritthaler H, Cordes U, Günther R, Schrezenmeir J, Beyer J. Selective blood sampling in adrenal hypertension. Cardiology 1985; 72 (Suppl. 01) 179-181
33 Baba Y, Nakajo M, Hayashi S. Adrenal venous catecholamine concentrations in patients with adrenal masses other than pheochromocytoma. Endocrine 2013; 43: 219-224
34 Gomez-Sanchez EP. Intracerebroventricular infusion of aldosterone induces hypertension in rats. Endocrinology 1986; 118: 819-823
35 Kontak AC, Wang Z, Arbique D, Adams-Huet B, Auchus RJ, Nesbitt SD, Victor RG, Vongpatanasin W. Reversible sympathetic overactivity in hypertensive patients with primary aldosteronism. J Clin Endocrinol Metab 2010; 95: 4756-4761
36 Miyajima E, Yamada Y, Yoshida Y, Matsukawa T, Shionoiri H, Tochikubo O, Ishii M. Muscle sympathetic nerve activity in renovascular hypertension and primary aldosteronism. Hypertension 1991; 17: 1057-1062
37 Wurtman RJ, Axelrod J. Control of enzymatic synthesis of adrenaline in the adrenal medulla by adrenal cortical steroids. J Biol Chem 1966; 241: 2301-2305
38 Gewirtz GP, Kvetnanský R, Weise VK, Kopin IJ. Effect of hypophysectomy on adrenal dopamine -hydroxylase activity in the rat. Mol Pharmacol 1971; 7: 163-168
39 Thoenen H, Mueller RA, Axelrod J. Trans-synaptic induction of adrenal tyrosine hydroxylase. J Pharmacol Exp Ther 1969; 169: 249-254
40 Cameron OG, Starkman MN, Schteingart DE. The effect of elevated systemic cortisol levels on plasma catecholamines in Cushing’s syndrome patients with and without depressed mood. J Psychiatr Res 1995; 29: 347-360
41 Krsek M, Rosická M, Nedvídková J, Kvasnicková H, Hána V, Marek J, Haluzík M, Lai EW, Pacák K. Increased lipolysis of subcutaneous abdominal adipose tissue and altered noradrenergic activity in patients with Cushing’s syndrome: an in-vivo microdialysis study. Physiol Res 2006; 55: 421-428
42 Mannelli M, Lanzillotti R, Pupilli C, Ianni L, Conti A, Serio M. Adrenal medulla secretion in Cushing’s syndrome. J Clin Endocrinol Metab 1994; 78: 1331-1335
43 Stene M, Panagiotis N, Tuck ML, Sowers JR, Mayes D, Berg G. Plasma norepinephrine levels are influenced by sodium intake, glucocorticoid administration, and circadian changes in normal man. J Clin Endocrinol Metab 1980; 51: 1340-1345
44 Valenta LJ, Elias AN, Eisenberg H. ACTH stimulation of adrenal epinephrine and norepinephrine release. Horm Res 1986; 23: 16-20
45 Srirangalingam U, Walker L, Khoo B, MacDonald F, Gardner D, Wilkin TJ, Skelly RH, George E, Spooner D, Monson JP, Grossman AB, Akker SA, Pollard PJ, Plowman N, Avril N, Berney DM, Burrin JM, Reznek RH, Kumar VKA, Maher ER, Chew SL. Clinical manifestations of familial paraganglioma and phaeochromocytomas in succinate dehydrogenase B (SDH-B) gene mutation carriers. Clin Endocrinol (Oxf) 2008; 69: 587-596
46 Srirangalingam U, Khoo B, Walker L, MacDonald F, Skelly RH, George E, Spooner D, Johnston LB, Monson JP, Grossman AB, Drake WM, Akker SA, Pollard PJ, Plowman N, Avril N, Berney DM, Burrin JM, Reznek RH, Kumar VKA, Maher ER, Chew SL. Contrasting clinical manifestations of SDHB and VHL associated chromaffin tumours. Endocr Relat Cancer 2009; 16: 515-525
47 Eisenhofer G, Lenders JWM, Timmers H, Mannelli M, Grebe SK, Hofbauer LC, Bornstein SR, Tiebel O, Adams K, Bratslavsky G, Linehan WM, Pacak K. Measurements of plasma methoxytyramine, normetanephrine, and metanephrine as discriminators of different hereditary forms of pheochromocytoma. Clin Chem 2011; 57: 411-420

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