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18-hydroxycorticosterone, 18-hydroxycortisol, and 18-oxocortisol in the diagnosis of primary aldosteronism and its subtypes.
[adrenal incidentaloma]
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
.
The
aim
of
the
study
was
to
evaluate
the
role
of
serum
18
-
hydroxycorticosterone
(
s
18
OHB
)
,
urinary
and
serum
18
-
hydroxycortisol
(
u-
and
s
18
OHF
)
,
and
urinary
and
serum
18
-
oxocortisol
(
u-
and
s
18
oxoF
)
in
the
diagnosis
of
PA
and
its
subtypes
,
aldosterone-producing
adenoma
(
APA
)
and
bilateral
adrenal
hyperplasia
(
BAH
)
.
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
.
We
measured
s
18
OHB
,
s
18
OHF
,
and
s
18
oxoF
before
and
after
saline
load
test
(
SLT
)
and
24
-
h
u
18
OHF
and
u
18
oxoF
.
PA
patients
displayed
significantly
higher
levels
of
s
18
OHB
,
u
18
OHF
,
and
u
18
oxoF
compared
to
EH
and
normal
subjects
;
APA
patients
displayed
s
18
OHB
,
u
18
OHF
,
and
u
18
oxoF
levels
significantly
higher
than
BAH
patients
.
Similar
results
were
obtained
for
s
18
OHF
and
s
18
oxoF
.
SLT
significantly
reduced
s
18
OHB
,
s
18
OHF
,
and
s
18
oxoF
in
all
groups
,
but
steroid
reduction
was
much
less
for
APA
patients
compared
to
BAH
and
EH
.
The
s
18
OHB
/
aldosterone
ratio
after
SLT
more
than
doubled
in
EH
but
remained
unchanged
in
APA
patients
.
u
18
OHF
,
u
18
oxoF
,
and
s
18
OHB
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
.
Diseases
Validation
Diseases presenting
"hypertension"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
aniridia
aromatase deficiency
cadasil
child syndrome
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cushing syndrome
cystinuria
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
fabry disease
familial hypocalciuric hypercalcemia
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kallmann syndrome
kindler syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
pendred syndrome
primary effusion lymphoma
scrub typhus
severe combined immunodeficiency
sneddon syndrome
typhoid
von hippel-lindau disease
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated