Objective: To investigate the usefulness of adrenal androgens for assessing the selectivity of adrenal venous sampling (AVS). Methods: Between January 2010 and December 2016, 37 consecutive patients [with an average age of (47±14) years, 16 males and 21 females] with primary aldosteronism (PA) who underwent AVS were enrolled. AVS procedures were performed with the bilateral simultaneous technique without cosyntropin stimulation. Cortisol, androstenedione, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEAS) concentrations were measured in adrenal venous (AV) and peripheral venous (PV) samples, respectively. Results: The selectivity index (SI) based on androstenedione and DHEA was higher than that of cortisol (SI-left: 13.9, 13.1 vs 6.05, P=0.006, 0.035; SI-right: 30.4, 18.5 vs 11.6, P=0.028, 0.051). However, the SI based on DHEAS was lower than that of cortisol (SI-left: 1.3 vs 6.0, P=0.002; SI-right: 1.5 vs 11.6, P=0.038). Plasma androstenedione and DHEA concentrations were positively correlated with cortisol and aldosterone in AV samples (all P<0.001). Compared to cortisol, the variation ratio of AV androstenedione and DHEA was lower from t(-15) to t(0) (0.23, 0.43 vs 0.52, both P<0.05). Using the receiver operating characteristic curve, a SI ≥ 3.0 for androstenedione or DHEA provided optimal sensitivity(97.7%, 91.9%) and specificity (93.8%, 93.8%) in AVS. Conclusion: Given the greater AV/PV ratios and reduced variability compared to cortisol, the adrenal androgens androstenedione and DHEA are useful for assessing the selectivity of AVS without cosyntropin stimulation and may be superior analytes in conditions with marked variability of cortisol levels or with adrenocortical tumors co-secreting cortisol and aldosterone.
目的： 评估肾上腺源性雄激素在肾上腺静脉采血（AVS）选择性判定中的应用。 方法： 回顾性研究。纳入2010年1月至2016年12月在南京大学医学院附属鼓楼医院明确诊断原发性醛固酮增多症（PA）并行AVS的37例患者，年龄（47±14）岁，男16例，女21例。采取双侧同步肾上腺静脉采血法，分别测定肾上腺静脉和外周静脉血中皮质醇、雄烯二酮、硫酸脱氢表雄酮（DHEAS）及脱氢表雄酮（DHEA）的浓度水平。 结果： 基于雄烯二酮和DHEA的选择性指数（SI）高于基于皮质醇的SI（左侧SI：13.9、13.1比6.05，P=0.006、0.035；右侧SI：30.4、18.5比11.6，P=0.028、0.051）。基于DHEAS的SI低于基于皮质醇的SI（左侧SI：1.3比6.0，P=0.002；右侧SI：1.5比11.6，P=0.038）。肾上腺静脉中雄烯二酮和DHEA浓度与血浆皮质醇的浓度呈正相关（均P<0.001）。－15~0 min雄烯二酮和DHEA的浓度变化率均小于皮质醇的浓度变化率（0.23、0.43比0.52，均P<0.05）。应用受试者工作特征（ROC）曲线，选择3.0作为基于雄烯二酮和DHEA的SI切点具有最佳的灵敏度（97.7%，91.9%）和特异度（93.8%，93.8%）。 结论： 与皮质醇相比，肾上腺源性雄激素雄烯二酮和DHEA在肾上腺静脉与外周静脉中的浓度差异更大，且变异性更小，可有效用于非促肾上腺皮质激素（ACTH）刺激采血法中选择性的判定。.
Keywords: Adrenal venous sampling; Androstenedione; Cortisol; Dehydroepiandrosterone; Hyperaldosteronism.