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Horm Metab Res 2017; 49(06): 418-423
DOI: 10.1055/s-0042-124419
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

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

Candy W.C. Sze   *
1   Department of Endocrinology, St Bartholomew’s Hospital, London, UK
,
Samuel Matthew O’Toole   *
1   Department of Endocrinology, St Bartholomew’s Hospital, London, UK
,
Roger Kent Tirador
1   Department of Endocrinology, St Bartholomew’s Hospital, London, UK
,
Scott A. Akker
1   Department of Endocrinology, St Bartholomew’s Hospital, London, UK
,
Matthew Matson
2   Department of Radiology, St Bartholomew’s Hospital, London, UK
,
Leslie Perry
3   Department of Biochemistry, St Bartholomew’s Hospital, London, UK
,
Maralyn Rose Druce
1   Department of Endocrinology, St Bartholomew’s Hospital, London, UK
,
Tanja Dekkers
4   Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
,
Jaap Deinum
4   Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
,
Jacques W.M. Lenders
4   Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
5   Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
Graeme Eisenhofer
5   Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
6   Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
,
William Martyn Drake
1   Department of Endocrinology, St Bartholomew’s Hospital, London, UK
› Author Affiliations
Further Information

Publication History

received 17 June 2016

accepted 13 December 2016

Publication Date:
26 April 2017 (online)

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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

* Denotes equal contribution


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