Grethe Å Ueland1,2, Paal Methlie1,2,3, Dag Eirik Jøssang4, Jørn V Sagen1,5, Kristin Viste5, Hrafnkell B Thordarson2, Anette Heie1,6, Marianne Grytaas1,2, Kristian Løvås1,2,3, Martin Biermann1,4, Eystein S Husebye1,2,3. 1. Department of Clinical Science, University of Bergen, Bergen, Norway. 2. Department of Medicine, Haukeland University Hospital, Bergen, Norway. 3. K.G. Jebsen Center for Autoimmune Disorders, University of Bergen, Bergen, Norway. 4. Department of Radiology, Haukeland University Hospital, Bergen, Norway. 5. Department of The Hormone Laboratory, Haukeland University Hospital, Bergen, Norway. 6. Department of Surgery, Haukeland University Hospital, Bergen, Norway.
Abstract
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.
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.
Authors: Gregory A Kline; Alexander Ah-Chi Leung; Davis Sam; Alex Chin; Benny So Journal: J Clin Endocrinol Metab Date: 2021-03-08 Impact factor: 5.958
Authors: German Rubinstein; Andrea Osswald; Leah Theresa Braun; Frederick Vogel; Matthias Kroiss; Stefan Pilz; Sinan Deniz; Laura Aigner; Thomas Knösel; Jérôme Bertherat; Lucas Bouys; Roland Ladurner; Anna Riester; Martin Bidlingmaier; Felix Beuschlein; Martin Reincke Journal: Endocrine Date: 2022-03-10 Impact factor: 3.925