![]() However, using aldosterone/metanephrine ratios (left 9.7 vs peripheral 2.4 right 1.3 vs peripheral 2.5), aldosterone production lateralized to the left with good contralateral suppression. On AVS, comparison of adrenal and peripheral A/F ratios (left 5.7 vs peripheral 1.0 right 1.7 vs peripheral 1.1) suggested bilateral aldosterone production, with the left gland dominant but without contralateral suppression. Failure of plasma cortisol to suppress overnight following dexamethasone and persistently suppressed corticotrophin were consistent with adrenal hypercortisolism. A 55-year-old hypertensive male had raised plasma aldosterone/renin ratios and PA confirmed by fludrocortisone suppression testing. We describe a case where metanephrine was measured during AVS to successfully circumvent this problem. Concomitant adrenal autonomous cortisol and aldosterone secretion therefore have the potential to confound AVS results. ![]() In patients with primary aldosteronism (PA) undergoing adrenal venous sampling (AVS), cortisol levels are measured to assess lateralization of aldosterone overproduction. ![]()
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