{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T08:26:19Z","timestamp":1769070379567,"version":"3.49.0"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,7,4]],"date-time":"2021-07-04T00:00:00Z","timestamp":1625356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["159533"],"award-info":[{"award-number":["159533"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Adrenal vein sampling (AVS) and computed tomography (CT) often show confusingly discordant lateralisation results in primary aldosteronism (PA). We tested a biochemical algorithm using AVS data to detect cortisol cosecretion as a potential explanation for discordant cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective analysis from a large PA\u2009+\u2009AVS database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>All patients with PA and AVS, 2005\u20132020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>An algorithm using biochemical data from paired AVS\u2009+\u2009CT images was devised from physiological first principles and informed by data from unilateral, AVS\u2013CT concordant patients. The algorithm involved calculations based upon the expectation that low cortisol levels exist in adrenal vein effluent opposite an aldosterone\u2010and\u2010cortisol\u2010producing adrenal mass and may reverse lateralisation due to inflated aldosterone\/cortisol ratios.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes<\/jats:title><jats:p>The algorithm was applied to cases with discordant CT\u2013AVS lateralisation to determine whether this might be a common or explanatory finding. Clinical and biochemical characteristics of identified cases were collected via chart review and compared to CT\u2013AVS concordant cases to detect evidence of biological plausibility for cortisol cosecretion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From a total of 588 AVS cases, 141 AVS\u2009+\u2009CT pairs were clear unilateral PA cases, used to develop the three\u2010step algorithm for AVS interpretation. Applied to 88 AVS\u2009+\u2009CT discordant pairs, the algorithm suggested possible cortisol cosecretion in 40%. Case review showed that the proposed cortisol cosecretors, as identified by the algorithm, had low\/suppressed adrenocorticotropic hormone levels, larger average nodule size\u00a0and lower plasma aldosterone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pending external validation and outcome verification by surgery and tissue immunohistochemistry, cortisol cosecretion from aldosteronomas may be a common explanation for discordant CT\u2013AVS results in PA.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14546","type":"journal-article","created":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T15:14:10Z","timestamp":1624461250000},"page":"123-131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Apparent failed and discordant adrenal vein sampling: A potential confounding role of cortisol cosecretion?"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8129-9360","authenticated-orcid":false,"given":"Gregory A.","family":"Kline","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, Cumming School of Medicine University of Calgary  Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benny","family":"So","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cumming School of Medicine University of Calgary  Calgary Alberta Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J. 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