Adrenal venous sampling is useful for a definitive diagnosis in Cushing's syndrome with bilateral adrenal tumors

Seki, Toshiro; Yasuda, Atsushi; Kitajima, Natsumi; Oki, Masayuki; Takagi, Atsushi; Nakamura, Naoya; Hanai, Kazuya; Terachi, Toshiro; Fukagawa, Masafumi

doi:10.1530/endoabs.41.ep77

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…Due to its advantage of being noninvasive, it was even thought that 131 I-NP-59 scintigraphy could replace catheterization of the adrenal veins. Several studies found that successfully performed scintigraphy imaging was consistent with AVS in cases of AICS with bilateral adrenal masses 19 . However, scintigraphy imaging is not widely used because it is unavailable in most hospitals in China and many other countries.…”

Section: Discussionmentioning

confidence: 99%

Role of adrenal venous sampling in the differential diagnosis and treatment protocol of ACTH-independent Cushing’s syndrome with bilateral adrenal lesions

An,

Chen,

et al. 2023

Endocrine

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Purpose: The diagnosis and management of corticotropin-independent Cushing's syndrome (AICS) with bilateral adrenal mass remain challenging. Some studies have explored the value of adrenal vein sampling (AVS) in patients with AICS; however, more investigations are needed to assess its bene ts for diagnosis and treatment planning in this population.Methods: Ten patients with imaging and biochemical evidence of AICS received AVS at our institution from 2017-2021, and their data, including demographics, laboratory results, adrenal mass and clinical characteristics, were analyzed. Serum cortisol and plasma aldosterone concentrations of the adrenal vein and inferior vena cava were measured. AVS-guided adrenalectomy was performed. Histology and immunohistochemistry of the adrenal tissues were analyzed. The prognosis was evaluated based on symptomatic improvement, serum cortisol normalization or both.Results: Bilateral adrenal mass were noted via computed tomography imaging in ten patients. The mean (± SD) maximal diameter of the adrenal mass was 1.84±0.93 cm (0.4-3.4 cm). Blood samples were successfully collected from both adrenal veins and inferior vena cava in seven patients, with lateralization index values ranging from 1.00-3.38. Blood from the right adrenal vein was not collected in three patients; instead of the lateralization index, their left adrenal vein to inferior vena cava cortisol gradient was analyzed. The AVS and postoperative pathological results were consistent. During the mean follow-up of 45.7 months, all ten patients achieved clinical improvement.Conclusion: Our study suggested that AVS helps distinguish unilateral disease from bilateral disease and localize autonomous hypercortisolism glands, thereby improving therapeutic strategy selection for patients with AICS and bilateral adrenal mass.

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Section: Discussionmentioning

confidence: 99%

Role of adrenal venous sampling in the differential diagnosis and treatment protocol of ACTH-independent Cushing’s syndrome with bilateral adrenal lesions

An,

Chen,

et al. 2023

Endocrine

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“…In some cases dexamethasone suppression prior to AVS has been used in order to suppress physiologic endogenous ACTH secretion [8, 10, 16] while in others it has not [13]. AVS has also been performed during simultaneous ACTH stimulation [17]. The interpretation of adequate catheterization varies as well.…”

Section: Discussionmentioning

confidence: 99%

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

et al. 2019

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PurposeTo study the usefulness of adrenal venous sampling (AVS) in distinguishing unilateral from bilateral cortisol production in patients with ACTH-independent hypercortisolism and bilateral adrenal lesions, or morphologically normal adrenal glands.MethodsA retrospective analysis of ten consecutive patients with ACTH-independent hypercortisolism who underwent AVS at our institution between 2009 and 2017. Unilateral dominant cortisol production was defined as a side-to-side cortisol/aldosterone lateralization ratio >2.ResultsFour of ten patients had overt Cushing’s syndrome. Of these, two had bilateral adrenal lesions on computed tomography and two had normal adrenal glands. One of the two patients with bilateral adrenal lesions had, based on the AVS, a unilateral dominant cortisol production. Following unilateral adrenalectomy the patient developed adrenal insufficiency. The other three patients were considered to have bilateral cortisol production and underwent bilateral adrenalectomy. Six patients had a mild autonomous cortisol secretion and bilateral adrenal lesions. Based on AVS, one patient was considered to have unilateral dominant cortisol production, underwent unilateral adrenalectomy and developed transient adrenal insufficiency postoperatively.ConclusionsAVS may contribute to appropriate treatment in patients with ACTH-independent hypercortisolism and bilateral adrenal lesions. In our series, AVS was helpful in the decision-making of two out of ten patients, avoiding chronic treatment with steroidogenesis inhibitors, or inappropriate bilateral adrenalectomy.

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“…Kitose klinikinių atvejų arba mažų tiriamųjų grupių analizėse aprašomos AVM tyrimo galimybės hiperkortizolemijos lateralizacijai nustatyti [14][15][16][17][18]. Daugumos šių tyrimų selektyvumui ir lateralizacijai vertinti naudotos W. Young ir bendraautorių pasiūlytos reikšmės.…”

Section: Tyrimo Objektas Ir Metodaiunclassified

Klinikinė Antinksčių Venų Mėginių Reikšmė Pacientams, Sergantiems Nuo Akth Nepriklausomu Kušingo Sindromu

Bučinskaitė,

Kaupas

2024

Health Sciences

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Nuo AKTH nepriklausomam Kušingo sindromui būdinga autonominė kortizolio sekrecija iš antinksčių ir sumažėjusi AKTH koncentracija plazmoje. Dažniausia priežastis, sukelianti autonominę kortizolio sekreciją, yra antinksčių adenoma. Retesnės priežastys: karcinoma, daugiamazgė antinksčių hiperplazija. Nėra patikimų radiologinių vaizdo ar klinikinių tyrimų, kurie tiksliai nustatytų kortizolio hipersekrecijos lateralizaciją antinksčiuose. Antinksčių venų mėginių tyrimas padėtų tiksliau diagnozuoti šį sutrikimą ir leistų parinkti tinkamiausią gydymą, tačiau ši procedūra neturi aiškių tarptautinių gairių, kurios leistų vertinti antinksčių venų mėginių sėkmingo atlikimo dažnį ir padidėjusios kortizolio gamybos lateralizaciją. Mokslinėje literatūroje aprašomi atlitki tyrimai, kuriuose autoriai taiko savo nustatytus antinksčių venų mėginių vertinimo kriterijus. Gauti rezultatai įrodo intervencinės procedūros naudą ir reikšmę, pasirenkant tolimesnį gydymo planą.

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Adrenal venous sampling is useful for a definitive diagnosis in Cushing's syndrome with bilateral adrenal tumors

Cited by 7 publications

References 17 publications

Role of adrenal venous sampling in the differential diagnosis and treatment protocol of ACTH-independent Cushing’s syndrome with bilateral adrenal lesions

Role of adrenal venous sampling in the differential diagnosis and treatment protocol of ACTH-independent Cushing’s syndrome with bilateral adrenal lesions

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

Klinikinė Antinksčių Venų Mėginių Reikšmė Pacientams, Sergantiems Nuo Akth Nepriklausomu Kušingo Sindromu

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