Liquid Chromatography-Tandem Mass Spectrometry Outperforms Radioimmunoassay in Guiding Surgical Decisions Based on Adrenal Venous Sampling in Primary Aldosteronism.

Publisher: Korean Endocrine Society Country of Publication: Korea (South) NLM ID: 101554139 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2093-5978 (Electronic) Linking ISSN: 2093596X NLM ISO Abbreviation: Endocrinol Metab (Seoul) Subsets: MEDLINE

Original Publication: Seoul : Korean Endocrine Society, [2010]-

Hyperaldosteronism*/surgery ; Hyperaldosteronism*/blood ; Hyperaldosteronism*/diagnosis ; Tandem Mass Spectrometry*/methods ; Adrenal Glands*/blood supply ; Adrenal Glands*/surgery ; Aldosterone*/blood ; Clinical Decision-Making*/methods; Chromatography, Liquid/methods ; Radioimmunoassay/methods ; Humans ; Female ; Male ; Middle Aged ; Adult ; Adrenalectomy ; Aged ; Veins ; Follow-Up Studies ; Retrospective Studies

Backgruound: Adrenal venous sampling (AVS) is essential for diagnosing unilateral aldosterone oversecretion in primary aldosteronism (PA). Traditionally, AVS relies on radioimmunoassay (RIA) to measure plasma aldosterone concentration (PAC), although RIA has limited specificity and considerable variability. This study evaluated the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS) in AVS and its impact on clinical outcomes.
Methods: Among 230 patients with PA (May 2020 to April 2023) who underwent AVS, successful sampling was achieved in 182 patients (79.1%) under unstimulated conditions and 206 patients (89.6%) under stimulated conditions. PAC levels from peripheral and adrenal veins measured by LC-MS/MS were compared with RIA results. Patient outcomes were categorized according to the Primary Aldosteronism Surgical Outcomes criteria.
Results: LC-MS/MS showed significant correlations with PAC levels measured by RIA in AVS (r=0.40 [unstimulated] and r=0.56 [stimulated]; both P<0.001). However, lateralization concordance between RIA and LC-MS/MS was moderate, at only 57.7% (unstimulated) and 64.6% (stimulated). LC-MS/MS identified more unilateral disease than RIA under both unstimulated (61.5% vs. 37.4%, P<0.001) and stimulated conditions (36.4% vs. 9.7%, P<0.001). Patients achieving complete clinical success after adrenalectomy were more accurately identified by LC-MS/MS than RIA under stimulated (55.6% vs. 22.2%, P=0.035), but not in unstimulated conditions.
Conclusion: LC-MS/MS outperformed RIA in identifying unilateral disease, resulting in higher rates of complete clinical success in adrenalectomy patients when surgical decisions were based on LC-MS/MS lateralization results.

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MOST-111-2628-B-002-025-MY3 Ministry of Science and Technology, Taiwan

Keywords: Adrenal venous sampling; Humans; Hyperaldosteronism; Mass spectrometry

4964P6T9RB (Aldosterone)

Date Created: 20250701 Date Completed: 20260102 Latest Revision: 20260107

20260130

PMC12765883

10.3803/EnM.2024.2237

40588822