Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with bilateral adrenal masses.
Cushing syndrome
adrenal glands
adrenal venous sampling
bilateral adrenal masses
cortisol lateralization Ratio
mild autonomous cortisol secretion
subclinical Cushing syndrome
Journal
Clinical endocrinology
ISSN: 1365-2265
Titre abrégé: Clin Endocrinol (Oxf)
Pays: England
ID NLM: 0346653
Informations de publication
Date de publication:
02 2023
02 2023
Historique:
revised:
14
10
2022
received:
13
04
2022
accepted:
17
10
2022
pubmed:
21
10
2022
medline:
4
1
2023
entrez:
20
10
2022
Statut:
ppublish
Résumé
The objective of this study was to evaluate the role of adrenal venous sampling (AVS) in guiding the management of patients with corticotropin (ACTH)-independent glucocorticoid secretory autonomy and bilateral adrenal masses. A cohort with 25 patients underwent AVS and surgical management. Cortisol was measured from the adrenal veins (AVs) and inferior vena cava (IVC). AV/IVC cortisol ratio and cortisol lateralization ratio (CLR) (dominant AV cortisol concentration divided by the nondominant AV cortisol concentration) were calculated. Posthoc receiver-operating characteristic curves were generated to determine the specificity of revised AV/IVC cortisol ratio and CLR in differentiating unilateral from bilateral disease. Patients underwent unilateral (n = 21) or bilateral (n = 4) adrenalectomy. The mean AV/IVC cortisol ratio for unilateral adrenalectomy was 12.1 ± 9.6 (dominant) and 4.7 ± 3.8 (contralateral) with a mean CLR of 3.6 ± 3.5. The mean AV/IVC cortisol ratio for bilateral adrenalectomy was 7.5 ± 2.1, with a mean CLR of 1.1 ± 0.6. At a mean follow-up of 22 months, one patient who underwent unilateral adrenalectomy for the predicted bilateral disease developed recurrent mild autonomous cortisol secretion. Posthoc analyses demonstrated a specificity of 95%-100% for unilateral disease with AV/IVC cortisol ratio >9 for one side, <2.0 for the opposite side and a CLR > 2.3. The specificity was 80%-90% for bilateral disease with AV/IVC cortisol ratio >5.1 bilaterally and a CLR < 1.1. Among patients with bilateral adrenal masses and ACTH-independent autonomous cortisol secretion, AVS can distinguish between unilateral and bilateral disease with high specificity and may guide surgical management.
Substances chimiques
Hydrocortisone
WI4X0X7BPJ
Adrenocorticotropic Hormone
9002-60-2
Aldosterone
4964P6T9RB
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
177-189Informations de copyright
© 2022 John Wiley & Sons Ltd.
Références
Bourdeau I, El Ghorayeb N, Gagnon N, Lacroix A. Management of endocrine disease: differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas. Eur J Endocrinol. 2018;179(2):R57-R67.
Chiodini I. Diagnosis and treatment of subclinical hypercortisolism. J Clin Endocrinol Metab. 2011;96(5):1223-1236.
Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016;175(2):G1-G34.
Terzolo M, Pia A, Reimondo G. Subclinical Cushing's syndrome: definition and management. Clin Endocrinol. 2012;76(1):12-18.
Di Dalmazi G, Pasquali R, Beuschlein F, Reincke M. Subclinical hypercortisolism: a state, a syndrome, or a disease? Eur J Endocrinol. 2015;173(4):M61-M71.
Tauchmanovà L, Rossi R, Biondi B, et al. Patients with subclinical Cushing's syndrome due to adrenal adenoma have increased cardiovascular risk. J Clin Endocrinol Metab. 2002;87(11):4872-4878.
Chiodini I, Morelli V, Salcuni AS, et al. Beneficial metabolic effects of prompt surgical treatment in patients with an adrenal incidentaloma causing biochemical hypercortisolism. J Clin Endocrinol Metab. 2010;95(6):2736-2745.
Toniato A, Merante-Boschin I, Opocher G, Pelizzo MR, Schiavi F, Ballotta E. Surgical versus conservative management for subclinical Cushing syndrome in adrenal incidentalomas: a prospective randomized study. Ann Surg. 2009;249(249):388-391.
Young WF, Jr., du Plessis H, Thompson GB, et al. The clinical conundrum of corticotropin-independent autonomous cortisol secretion in patients with bilateral adrenal masses. World J Surg. 2008;32(5):856-862.
Patrova J, Jarocka I, Wahrenberg H, Falhammar H. Clinical outcomes in adrenal incidentaloma: experience from one center. Endocr Pract. 2015;21(8):870-877.
Young WF, Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356(6):601-610.
Debillon E, Velayoudom-Cephise F, Salenave S, et al. Unilateral adrenalectomy as a first-line treatment of Cushing's syndrome in patients with primary bilateral macronodular adrenal hyperplasia. J Clin Endocrinol Metab. 2015;100(12):4417-4424.
Iacobone M, Albiger N, Scaroni C, et al. The role of unilateral adrenalectomy in ACTH-independent macronodular adrenal hyperplasia (AIMAH). World J Surg. 2008;32(5):882-889.
Nugent CA. Diagnosis of Cushing's syndrome; single dose dexamethasone suppression test. Arch Intern Med. 1965;116:172-176.
Ueland GÅ, Methlie P, Jøssang DE, et al. Adrenal venous sampling for assessment of autonomous cortisol secretion. J Clin Endocrinol Metab. 2018;103(12):4553-4560.
Andrews JC, Thompson SM, Young WF. A coaxial guide wire-catheter technique to facilitate right adrenal vein sampling: evaluation in 76 patients. J Vasc Interv Radiol. 2015;26(12):1871-1873.
Dream S, Park S, Yen T, et al. Utility of epinephrine levels in determining adrenal vein cannulation during adrenal venous sampling for primary aldosteronism. Endocr Pract. 2022;28:276-281.
Caoili EM, Korobkin M, Francis IR, et al. Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology. 2002;222(3):629-633.
Schieda N, Siegelman ES. Update on CT and MRI of adrenal nodules. Am J Roentgenol. 2017;208(6):1206-1217.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377-381.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inf. 2019;95:103208.
Osswald A, Quinkler M, Di Dalmazi G, et al. Long-Term outcome of primary bilateral macronodular adrenocortical hyperplasia after unilateral adrenalectomy. J Clin Endocrinol Metab. 2019;104(7):2985-2993.
Rubinstein G, Osswald A, Braun LT, et al. The role of adrenal venous sampling (AVS) in primary bilateral macronodular adrenocortical hyperplasia (PBMAH): a study of 16 patients. Endocrine. 2022;76:434-445.
Albiger NM, Regazzo D, Iacobone M, Scaroni C. Different therapeutic options in patients with Cushing's syndrome due to bilateral macronodular adrenal hyperplasia. Minerva Endocrinol. 2019;44(2):205-220.
Xu Y, Rui W, Qi Y, et al. The role of unilateral adrenalectomy in corticotropin-independent bilateral adrenocortical hyperplasias. World J Surg. 2013;37(7):1626-1632.
Tanno F, Srougi V, Almeida M, et al. A new insight into the surgical treatment of primary macronodular adrenal hyperplasia. J Endocr Soc. 2020;4(8):1-14.
Wurth R, Tirosh A, Kamilaris C, et al. Columetric modeling of adrenal gland size in primary bilateral macronodular adrenocortical hyperplasia. J Endo Soc. 2021;5(1):1-9.
Acharya R, Dhir M, Bandi R, Yip L, Challinor S. Outcomes of adrenal venous sampling in patients with bilateral adrenal masses and ACTH-Independent Cushing's syndrome. World J Surg. 2019;43(2):527-533.