The method of differential diagnosis of the main forms of primary hyperaldosteronism by high performance liquid chromatography

Objective. To provide a method of differential diagnosis of the main forms of primary hyperaldosteronism (PHA) based on the high effective liquid chromatography (HELC). Design and methods. We evaluated 98 patients with PHA and with essential hypertension (EHTN). Aldosterone and plasma renin activity were measured by radioimmunoassay, renin levels by immunoassay. The blood levels of cortisol (F), cortisone (E), corticosterone (B), 11‑deoxycorticosterone (DOC), 11‑dehydrocortitocosterone (A), 11‑deoxycortisol (S), 18‑hydroxycorticosterone (18‑OH-B), the urinary excretion of free cortisol (UFF), free cortisone (UFE), 18‑hydroxycorticosterone (U18‑OH-B) were measured by HELC. Dexamethasone test, saline infusion test, postural test, computed tomography of adrenal glands were performed. All PHA patients underwent adrenal vein sampling (AVS). Results. PHA patients had higher blood levels of B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B than EHTN patients. Moreover, patients with aldosteroma had combined excess of blood B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B, patients with idiopathic hyperaldosteronism (IHA) showed a reduction of F/E and B/А blood ratios and UFF/UFE urine ratio. The blood levels of B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B showed the highest sensitivity and specificity for the diagnosis of PHA. Patients with aldosteroma showed higher levels of B and 18‑OH-B, higher ratios B/А, B/F and 18‑OHB/F in the adrenal vein blood at the tumor side as compared with those in patients with IHA. Conclusions. B, DOC, 18‑OH-B blood levels and U18‑OH-B urinary excretion determined by HELC are informative and reliable indicators for early diagnosis of PHA. The use of HELC method in a complex examination of PHA patients is necessary in case of aldosterone-renin ratio between 30 and 50 ng/dl per ng/(ml per hour) and in case of borderline values of lateralization coefficient at AVS.

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