PP.23.02: COULD THE PHASE OF THE MENSTRUAL CYCLE AFFECT THE RESULTS OF ADRENAL VENOUS SAMPLING AND SUBTYPING OUTCOME OF PRIMARY ALDOSTERONISM?. (June 2015)

• Record Type: Journal Article
• Authors: Ahmed, A.; Gordon, R.; Ward, G.; Wolley, M.; Simmons, P.; Stowasser, M.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000468415.79325.ac
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Since aldosterone and cortisol levels vary during the menstrual cycle, and are utilised in the interpretation of adrenal venous sampling (AVS) to differentiate unilateral from bilateral primary aldosteronism, outcome of AVS in premenopausal women could possibly be influenced by when the collections are made. We assessed the effect of phase of the menstrual cycle on both adrenal and peripheral venous aldosterone and cortisol levels and on serum female sex steroid levels during AVS. Design and method: In 23 premenopausal women with primary aldosteronism undergoing AVS, levels of aldosterone, cortisol, progesterone, estradiol, LH and FSH levels were compared, depending on whether collected during the follicular or luteal phase Results: Based on results at AVS, 10 women had unilateral over-production of aldosterone, and 13 bilateral. Unilateral aldosterone over-production was observed more frequently in women undergoing AVS during the luteal phase compared with the follicular phase (7/10 = 70% vs 3/13 = 23%; p < 0.05). Simultaneously collected peripheral levels of progesterone (p < 0.0001), estradiol (p < 0.05) and aldosterone (p < 0.05) and bilateral adrenal venous levels of aldosterone (p < 0.01) and cortisol (p < 0.01) were higher in those sampled during the luteal phase. Importantly, higher/lower side adrenal venous aldosterone/cortisol ratios (i.e. lateralization indices) were higher during the luteal phase than follicular [median 11 (range 2.94–96) vs 2 (1.23–35), (p < 0.05)]. Conclusions: The phase of the menstrual cycle during which samples are collected significantly affects the levels of aldosterone and cortisol used to interpret AVS. A risk of false lateralization appears to be present when AVS is performed during the luteal phase, but this requires confirmation with larger patient numbers, ideally with studies in each patient during both phases. Meanwhile, recording of the phase of the cycle during which AVS is performed should be encouraged.