Related Experiment Video
Updated: Jun 14, 2025
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
The Effectiveness of Metanephrine-Based Compared with Cortisol-Based Measurements to Assess Selectivity and
Ibrahim Mohammad Nadeem1, Yusra Rahman2, Laiba Nadeem3
1Department of Medical, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Purpose:
To evaluate the effectiveness of metanephrine-based compared with cortisol-based measurements in assessing successful adrenal vein (AV) cannulation to determine diagnostic AV sampling (AVS) procedures.
Materials And Methods:
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a literature search was conducted using 3 electronic medical databases-PubMed, Embase, and MEDLINE-from inception to the third week of December 2024. Studies that compared metanephrine-based with cortisol-based measurements in adult patients with biochemically established primary aldosteronism undergoing AVS were included. The Methodological Index for Non-Randomized Studies appraisal tool was used for quality assessment. Cohen κ statistic, proportion differences, 95% confidence intervals (CIs), and 2-tailed P values using Z-test for paired proportions were calculated, where applicable.
Results:
Six studies evaluating a total of 531 patients were included. Metanephrine-based selectivity index (SI) demonstrated significantly higher successful cannulation rates than cortisol-based SI in unstimulated AVS procedures for almost all the comparisons (P < .05), whereas no significant difference was found in stimulated procedures (P > .05). There was excellent agreement between metanephrine-based and cortisol-based SI (κ = 0.876; 95% CI, 0.779-0.972; n = 117) and substantial agreement for lateralization index (LI) (κ = 0.773; 95% CI, 0.658-0.889; n = 115). In patients successfully treated with adrenalectomy, no significant difference was found between metanephrine-based and cortisol-based LIs in identifying dominant side (n = 28).
Conclusions:
This study was limited by the quality of evidence and heterogeneity. Compared with cortisol-based SI, metanephrine-based SI significantly increased the proportion of diagnostic unstimulated AVS procedures, supporting the use of metanephrine-based measurements as a reliable alternative.
Related Concept Videos
01:30Adrenergic Agonists: Direct-Acting Agents
These agents can be classified...
01:25Dose-Response Relationship: Selectivity and Specificity
01:31Hormones of the Adrenal Glands
The adrenal cortex, a powerhouse of hormone synthesis, generates over two dozen corticosteroid hormones. The zona glomerulosa produces mineralocorticoids, exemplified by aldosterone, influencing the electrolyte composition of body fluids. The synthesis of glucocorticoids such as cortisol and...
01:30Adrenergic Agonists: Therapeutic Uses
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:26Adrenergic Receptors: β Subtype
Isoprenaline > Adrenaline > Noradrenaline
Neurotransmitter binding to these receptors causes activation of adenylyl cyclase resulting in increased concentrations of cAMP and modulation of calcium ion channels within the cell. They are further classified into β1, β2, and β3 subtypes.
β1-adrenoceptors: β1-adrenoceptors...