Outcomes of Adrenal Venous Sampling in Patients with Bilateral Adrenal Masses and ACTH‐Independent Cushing’s Syndrome

Acharya, Runa; Dhir, Mashaal; Bandi, Rupal; Yip, Linwah; Challinor, Sue M.

doi:10.1007/s00268-018-4788-2

Cited by 32 publications

(19 citation statements)

References 19 publications

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“…Therefore, AVS, which is used for the diagnosis and subtype confirmation of hyperaldosteronism, might be a useful diagnostic tool. 5 , 8 , 10 , 11 However, unlike PA, 10 the concentration of cortisol in adrenal adenoma is increased. Therefore, adrenal-to-peripheral venous cortisol concentrations cannot be used to confirm a correct catheter position.…”

Section: Discussionmentioning

confidence: 98%

<p>Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy</p>

Zhou

Liu

Zhang

et al. 2020

DMSO

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Aim: Hypercortisolism is characterized by metabolic disorders and high mortality rates. Adrenalectomy and medical therapies are considered major treatment options. However, some patients, especially young patients, are strongly against undergoing surgery in case of secondary hypocortisolism or relapses that require replacement supplements or pharmacological interventions. In such cases, alternative therapies are needed to treat hypercortisolism. Methods: We report a 27-year-old Chinese female with adrenal cortisol-producing adenoma. The patient's circadian rhythm and concentrations of cortisol were abnormal, accompanying with an increased 24-hour urinary cortisol level. Computed tomography (CT) revealed a nodular soft-tissue mass in the right adrenal gland. Results: Cortisol hypersecretion from the right adrenal gland was verified by adrenal venous sampling (AVS). Adrenal artery ablation was performed. After ablation, long-term follow-up showed that the patient's symptoms subsided and abnormal laboratory test results returned to normal without pharmacological treatment. Conclusion: AVS might be a promising method to aid the diagnosis of cortisol-producing adenoma. Adrenal artery ablation is minimally invasive and may be useful for the treatment of adrenal adenoma or nodular diseases, especially in patients who cannot undergo surgery.

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Section: Discussionmentioning

confidence: 98%

<p>Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy</p>

Zhou

Liu

Zhang

et al. 2020

DMSO

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“…The results of this groundbreaking study have recently been questioned by Acharya et al (17) who, using criteria of Funder et al (16), failed to confirm the lateralization of adrenal adenomas, probably due to patient selection criteria as mentioned in the study (17). Instead, the group focused on the morphology identified at the computer tomography scan, and surgically excised accordingly the larger suprarenal multinodular gland, thus avoiding a life-altering bilateral suprarenalectomy.…”

Section: Current Diagnostic Criteria and Surgical Treatment Optionsmentioning

confidence: 92%

The importance of adrenal venous sampling in ACTH‑independent Cushing syndrome: A case report and literature review

Tulin

Tomescu

et al. 2021

Exp Ther Med

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Independent Cushing's adrenocorticotropic hormone (ACTH) syndrome can have several causes, including adrenal carcinoma or simple adrenal hyperplasia. Although the distinction between malignant and benign can be effectively made through imaging investigations, in the situation where there are bilateral formations, their hormonal activity is impossible to appreciate via non-invasive techniques. The present study includes the presentation of a clinical case on the basis of which a literature review was made. The clinical case pertains to a 32-year-old patient with ACTH-independent Cushing's syndrome and bilateral adrenal tumor formations leading to the utility of adrenal venous sampling to avoid bilateral adrenalectomy. A literature review was subsequently conducted focusing on articles pertaining to the PICO criteria in order to describe: The diagnosis of adrenal tumor masses, the decision on the type of surgery and most importantly, the impact of adrenal venous sampling in avoiding surgical resection. These interventions severely limit the patients' quality of life.

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“…However, the source of excess cortisol in AICS could be localized using AVS. Multiple case reports have suggested that AVS may be used to successfully localize excess cortisol in patients with AICS (16,(33)(34)(35)(36)(37). In the case of a 40-year-old woman from China with a large pelvic mass, AVS also aided localization of ectopic AICS (15).…”

Section: Adrenocorticotropic Hormone Independent Cushing Syndromementioning

confidence: 99%

Recent Advances in the Clinical Application of Adrenal Vein Sampling

Zhong

Zhang

et al. 2022

Front. Endocrinol.

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We reviewed clinical research investigating the applications of adrenal vein sampling (AVS). AVS could be applied not only to primary aldosteronism (PA) but also to other endocrine diseases, such as adrenocorticotropic hormone (ACTH) independent Cushing syndrome (AICS) and hyperandrogenemia (HA). However, the AVS protocol requires improvements to increase its success rate. Using the computed tomography image fusion, coaxial guidewire technique, and fast intraprocedural cortisol testing (CCF) technique could improve the success rate of catheterization in AVS for PA. ACTH loading could be considered in medical centers with a low selectivity of AVS for PA but is not essential in those with mature AVS technology. The continuous infusion method should be recommended for ACTH stimulation in AVS for PA to reduce adverse events. AVS has not been routinely recommended before management decisions in AICS, but several studies verified that AVS was useful in finding out the source of excess cortisol, especially for distinguishing unilateral from bilateral disease. However, it is necessary to reassess the results of AVS in AICS with the use of reference hormones to fully normalize cortisol levels. In addition, it is essential to determine the optimal model that combines AVS results and mass size to guide the selection of surgical plans, including identifying the dominant gland and presenting the option of staged adrenalectomy, to minimize the impact of bilateral resection. For HA, AVS combined with ovarian intravenous sampling to locate excess androgens could be considered when imaging results are equivocal.

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Outcomes of Adrenal Venous Sampling in Patients with Bilateral Adrenal Masses and ACTH‐Independent Cushing’s Syndrome

Cited by 32 publications

References 19 publications

<p>Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy</p>

<p>Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy</p>

The importance of adrenal venous sampling in ACTH‑independent Cushing syndrome: A case report and literature review

Recent Advances in the Clinical Application of Adrenal Vein Sampling

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