Low grade cortisol co-secretion has limited impact on ACTH-stimulated AVS parameters in primary aldosteronism.

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In primary aldosteronism, co-secretion of cortisol may alter cortisol-derived adrenal venous sampling indices.To identify whether cortisol co-secretion in primary aldosteronism alters adrenal venous sampling parameters and interpretation.Retrospective case-control study.A tertiary referral centre.144 adult patients with primary aldosteronism who had undergone both adrenocorticotropic hormone-stimulated adrenal venous sampling and dexamethasone suppression testing between 2004 and 2018.Adrenal venous sampling indices including adrenal vein aldosterone/cortisol ratios and the selectivity, lateralisation and contralateral suppression indices.21 (14.6%) patients had evidence of cortisol co-secretion (defined as a failure to suppress cortisol to < 50 nmol/L post dexamethasone). Patients with evidence of cortisol co-secretion had a higher inferior vena cava cortisol concentration (p=0.01) than those without. No difference was observed between the groups in terms of selectivity index, lateralisation index, lateralisation of aldosterone excess or adrenal vein cannulation rate.Cortisol co-secretion alters some parameters in adrenocorticotrophic hormone-stimulated adrenal venous sampling but does not result in alterations in patient management.

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