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Tytuł:
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Adrenal Venous Sampling for Assessment of Autonomous Cortisol Secretion.
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Autorzy:
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Ueland GÅ; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Methlie P; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Medicine, Haukeland University Hospital, Bergen, Norway.; K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.
Jøssang DE; Department of Radiology, Haukeland University Hospital, Bergen, Norway.
Sagen JV; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.
Viste K; Department of The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway.
Thordarson HB; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Heie A; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Surgery, Haukeland University Hospital, Bergen, Norway.
Grytaas M; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Løvås K; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Medicine, Haukeland University Hospital, Bergen, Norway.; K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.
Biermann M; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Radiology, Haukeland University Hospital, Bergen, Norway.
Husebye ES; Department of Clinical Science, University of Bergen, Bergen, Norway.; Department of Medicine, Haukeland University Hospital, Bergen, Norway.; K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway.
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Źródło:
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The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2018 Dec 01; Vol. 103 (12), pp. 4553-4560.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2017- : New York : Oxford University Press
Original Publication: Springfield, Ill. : Charles C. Thomas
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MeSH Terms:
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Adrenal Gland Neoplasms/*diagnosis
Adrenal Glands/*metabolism
Cushing Syndrome/*diagnosis
Hydrocortisone/*blood
Hyperaldosteronism/*diagnosis
Adrenal Gland Neoplasms/blood ; Adrenal Gland Neoplasms/complications ; Adrenal Glands/blood supply ; Adrenal Glands/diagnostic imaging ; Adult ; Aged ; Catheterization/methods ; Cholesterol/administration & dosage ; Cholesterol/chemistry ; Contrast Media/administration & dosage ; Cushing Syndrome/blood ; Cushing Syndrome/complications ; Diagnosis, Differential ; Feasibility Studies ; Female ; Femoral Vein/surgery ; Humans ; Hydrocortisone/metabolism ; Hyperaldosteronism/blood ; Hyperaldosteronism/etiology ; Iodine Radioisotopes/administration & dosage ; Iodine Radioisotopes/chemistry ; Male ; Middle Aged ; Prospective Studies ; Radionuclide Imaging/methods ; Tomography, X-Ray Computed
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Molecular Sequence:
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ClinicalTrials.gov NCT02543697
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Substance Nomenclature:
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0 (Contrast Media)
0 (Iodine Radioisotopes)
0 (Iodine-131)
97C5T2UQ7J (Cholesterol)
WI4X0X7BPJ (Hydrocortisone)
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Entry Date(s):
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Date Created: 20180824 Date Completed: 20190911 Latest Revision: 20190911
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Update Code:
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20240105
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DOI:
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10.1210/jc.2018-01198
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PMID:
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30137397
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Context: Autonomous cortisol secretion (ACS) can be unilateral or bilateral irrespective of the presence of an adrenal tumor. A reliable method to distinguish between unilateral and bilateral ACS is lacking.
Objective: Evaluate the use of adrenal venous sampling (AVS) to distinguish between unilateral and bilateral ACS.
Design and Methods: This was a prospective study of AVS in patients with adrenal tumors who received a diagnosis of ACS or adrenal Cushing syndrome (CS). Unilateral secretion was defined as >2.3-fold difference in cortisol levels between the two adrenal veins. Metanephrine levels were used to ascertain correct catheter position. Results were correlated with findings on CT and iodine-131-cholesterol scintigraphy.
Results: Thirty-nine patients underwent AVS; there were no complications. The procedure was inconclusive in six patients and repeated with success in one, giving a success rate of 85%, and leaving 34 procedures for evaluation (adrenal CS, n = 2; ACS, n = 32). Of 14 patients with bilateral tumors, 10 had bilateral and 4 had unilateral overproduction. Of 20 patients with unilateral tumors, 11 had lateralization to the side of the tumor and the remaining had bilateral secretion. Cholesterol scintigraphy findings were concordant with those of AVS in 13 of 18 cases (72%) and discordant in 5 (28%).
Conclusion: Laterality of ACS does not always correspond to findings on CT images. AVS is a safe and valuable tool for differentiation between unilateral and bilateral cortisol secretion and should be considered when operative treatment of ACS is a possibility.
