Successful Adrenal Vein Sampling Using Dexamethasone Premedication in Patients With Iodine Contrast Media Allergy.

Context: Preparation of patients with iodine contrast media (ICM) allergy who require adrenal vein sampling (AVS) to establish source of aldosterone excess of their confirmed primary aldosteronism (PA) is controversial. Usual premedication with high-dose prednisone can interfere with cortisol determinations, possibly altering the aldosterone to cortisol ratios for the identification of lateralized aldosterone excess. Objective: We aimed to evaluate the efficacy and safety of premedication with high-dose dexamethasone to perform AVS in patients with ICM. Methods: One hundred and seventy-seven consecutive patients with confirmed PA who underwent bilateral simultaneous basal and post-ACTH bolus AVS at our center between January 2010 and December 2020 were retrospectively analyzed for history of ICM allergy. A total of 7 patients (4%) with previous allergic reactions to ICM were prepared with 3 doses of 7.5 mg dexamethasone premedication rather than the usual 50 mg of prednisone. Results: No breakthrough allergic reactions were reported in the 7 patients. Despite adequate serum cortisol suppression following dexamethasone, the basal and post-ACTH selectivity index were respectively > 2 and > 5 bilaterally in all patients, confirming adequate cannulation of both adrenal veins. Four patients had lateralized ratios (A/C ratio > 2 basally and > 4 post-ACTH), while 3 had bilateral source during AVS study. In the 3 patients undergoing unilateral adrenalectomy for lateralized source and contralateral suppression and adequate follow-up data, cure of PA was achieved at mean 58 months postoperatively. Conclusion: AVS using dexamethasone premedication is safe and accurate for diagnosing the source of aldosterone excess in patients with PA and ICM allergy.

Approach to the patient with adrenocortical carcinoma.

Adrenocortical cancer (ACC) is a rare and often aggressive malignancy that requires multidisciplinary expertise for optimal management. It can present with symptoms of rapidly appearing excess steroid secretion or an abdominal mass, or it can be discovered incidentally. Thorough imaging and endocrine evaluations can identify the majority of ACCs amongst adrenal tumors; however, some smaller ACCs are better identified using fluorodeoxyglucose-positron emission tomography/computed tomography scan. Complete resection by an expert surgeon is the only potentially curative treatment for ACC, and tumor spillage should be avoided. Histopathology is important for diagnosis, but immunohistochemistry markers and gene profiling of the resected tumor may become superior to current staging systems to stratify prognosis. Despite complete resection in stage I-III tumors, approximately 40% of patients develop metastasis within 2 yr. Some retrospective studies indicate that adjuvant mitotane therapy prolongs disease-free survival, leading several centers to recommend its administration; prospective studies are under way to provide future evidence-based recommendations. For locally invading ACC, extensive en bloc resection is attempted, followed by adjuvant mitotane and, in selected cases, adjuvant radiotherapy. When ACC is not surgically resectable, mitotane therapy is adjusted to reach serum levels of 14-20 µg/ml. Careful replacement of glucocorticoid and mineralocorticoid deficiency after surgery or mitotane therapy is important; steroid excess from remaining tumor burden should also be controlled to avoid its morbidities. For metastatic disease, combination chemotherapy should be administered, if possible, in the context of multicenter collaborative research protocols. New insights in the molecular pathogenesis of ACC should allow the development of improved targeted therapies.

Sexually attractive phrases increase yolk androgens deposition in Canaries (Serinus canaria).

The androgen concentration in birds' eggs varies with laying order, breeding conditions, and mate attractiveness. In passerine birds, mate attractiveness depends upon song quality. The aim of our study was to evaluate the effect of one criterion used by females to assess male song quality that is to say the presence of sexually attractive phrases on yolk androgen deposition. Twenty-five female Canaries were assigned to three experimental groups; in the first group, the females were allowed to hear songs made up with attractive phrases; in the second group, they were allowed to hear songs made up with non-attractive phrases; and in the control group, the females could not hear any song. Our results show that females allowed to hear songs with attractive phrases deposit significantly higher amounts of androgens (mostly testosterone) in their eggs than females without acoustical stimulation. The females exposed to songs with non-attractive phrases had androgen amounts halfway between the two other groups. This suggests that when females are paired with mates able to sing attractive phrases they can allocate more androgens in their eggs during the pre-laying period.

Plasma steroid and nutrient levels during the active season in wild Testudo horsfieldi.

Plasma concentrations of sex steroids (testosterone and progesterone), proteins (total protein and albumin), lipids (phospholipids, cholesterol, and triglycerides), and minerals (calcium and phosphorus) were measured in wild Testudo horsfieldi in Uzbekistan, during the short, 3-month activity period (March-May, 1998). Testosterone concentration in males was highest (52 ng/ml) when they had just emerged from brumation (hibernation) in mid-March, which was also the beginning of the mating period, and fell in April. In females, progesterone peaked in mid-April (at 10 ng/ml), just before ovulation of the first clutches at the end of April and beginning of May. Testosterone levels in females and progesterone levels in males were low (<3 ng/ml) throughout the activity period. In general, the plasma concentrations of proteins, lipids, and phosphorus increased slowly in males, but more rapidly in females, during the activity season. These increases were particularly strong in females in the second half of April, coinciding with the peaks in female hormone levels. The changes in plasma hormones and nutrients reflected the timing of the different behaviours. The four first weeks of above-ground activity (mid-March to mid-April) by males, when they had high testosterone levels, were primarily allocated to fighting other males, courtship, and mating, while females spent much of that time feeding. Thereafter, both sexes concentrated on feeding. Females were probably preparing to ovulate in late-April, when their progesterone levels were highest and when plasma nutrient levels increased considerably.