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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
"bilateral adrenal hyperplasia"
symptom
adrenal incidentaloma
congenital adrenal hyperplasia
cushing syndrome
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