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The role of adrenal venous sampling (AVS) in primary bilateral macronodular adrenocortical hyperplasia (PBMAH): a study of 16 patients.
Rubinstein, German; Osswald, Andrea; Braun, Leah Theresa; Vogel, Frederick; Kroiss, Matthias; Pilz, Stefan; Deniz, Sinan; Aigner, Laura; Knösel, Thomas; Bertherat, Jérôme; Bouys, Lucas; Ladurner, Roland; Riester, Anna; Bidlingmaier, Martin; Beuschlein, Felix; Reincke, Martin.
Afiliação
  • Rubinstein G; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.
  • Osswald A; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.
  • Braun LT; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.
  • Vogel F; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.
  • Kroiss M; Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.
  • Pilz S; Department of Internal Medicine I, Division of Endocrinology and Diabetes, University of Würzburg, University Hospital Würzburg, Würzburg, Germany.
  • Deniz S; Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
  • Aigner L; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, München, Germany.
  • Knösel T; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, München, Germany.
  • Bertherat J; Department for Diagnostic and Interventional Radiology and Neuroradiology, Klinikverbund Allgäu, Kempten, Germany.
  • Bouys L; Pathologisches Institut, Klinikum der Universität München, München, Deutschland.
  • Ladurner R; Université de Paris, 75006, Paris, France.
  • Riester A; Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France.
  • Bidlingmaier M; Université de Paris, 75006, Paris, France.
  • Beuschlein F; Department of Endocrinology, Center for Rare Adrenal Diseases, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014, Paris, France.
  • Reincke M; Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Campus Innenstadt, Klinikum der Universität München, München, Germany.
Endocrine ; 76(2): 434-445, 2022 05.
Article em En | MEDLINE | ID: mdl-35274284
OBJECTIVE: Primary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a rare cause of ACTH-independent Cushing's syndrome. Current guidelines recommend bilateral adrenalectomy for PBMAH, but several studies showed clinical effectiveness of unilateral adrenalectomy despite bilateral disease in selected patients. Our aim was to evaluate the gain of information which can be obtained through adrenal venous sampling (AVS) based cortisol lateralization ratios for guidance of unilateral adrenalectomy. DESIGN: We performed a retrospective analysis of 16 patients with PBMAH and clinical overt cortisol secretion in three centers METHODS: Selectivity of adrenal vein sampling during AVS was defined as a gradient of cortisol or a reference adrenal hormone ≥2.0 between adrenal and peripheral vein. Lateralization was assumed if the dominant to non-dominant ratio of cortisol to reference hormone was ≥4.0. RESULTS: AVS was technically successful in all patients based on absolute cortisol levels and in 13 of 16 patients (81%) based on reference hormone levels. Lateralization was documented in 8 of 16 patients. In patients with lateralization, in 5 of 8 cases this occurred toward morphologically larger adrenals, while in 3 patients lateralization was present in bilaterally identical adrenals. The combined volume of adrenals correlated positively with urinary free cortisol, suggesting that adrenal size is the dominant determinant of cortisol secretion. CONCLUSIONS: In this study the gain of information through AVS for unilateral adrenalectomy was limited in patients with PBMAH and marked adrenal asymmetry.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hidrocortisona / Síndrome de Cushing Tipo de estudo: Etiology_studies / Guideline / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hidrocortisona / Síndrome de Cushing Tipo de estudo: Etiology_studies / Guideline / Observational_studies Limite: Humans Idioma: En Ano de publicação: 2022 Tipo de documento: Article