Usefulness of steroid profiling in the diagnosis of primary Aldosteronism a systematic review.

OBJECTIVE: To summarize studies evaluating the utility of steroid profiling and metabolomics in the diagnosis (differentiation from other causes of hypertension) and subtyping (unilateral vs. bilateral) of primary aldosteronism (PA). METHODS: We systematically searched PubMed and Embase databases for studies published up to March 31,2024, that assessed metabolomics-based approaches (serum, plasma and urine), for the diagnosis or subtyping of PA. RESULTS: A total of 32 articles involving 2851 participants with PA were included. Of these, six assessed both diagnosis and subtyping, 13 focused solely on diagnosis, and 13 on subtyping. Eight studies used exclusively urine samples, and the most common used metabolomics platform was LC-MS/MS. The number of metabolites analyzed varied: 37.5% of studies assessed fewer than 10 metabolites; 43.8% assessed 10–50, and 18.7% analyzed more than 50. Only one study incorporated plasma miRNAs. Overall, patients with PA exhibited higher levels of 18-hydroxycortisol (18OHF), 18-Oxocortisol (18oxoF), 18-hydroxycorticosterone (18OHB), and tetrahydro-aldosterone (THAldo) compared to patients with other types of hypertensions. Regarding subtyping, most studies found that unilateral PA was associated with elevated levels of 18OHF, 18oxoF, 18OHB and 11-deoxycorticosterone (DOC) while having lower levels of dehydroepiandrosterone (DHEA) and DHEA-sulphate (DHEA-S) than bilateral PA patients. CONCLUSION: Steroid metabolites such as 18OHB, 18oxoF, and 18OHF appear to be the most valuable markers for the diagnosis and subtyping of PA. Additionally, androgens levels may assist in differentiating unilateral from bilateral PA.