Rapid intraoperative cortisol assay: design and utility for localizing adrenal tumors by venous sampling

Woods, J.J.; Sampson, Maureen; Ruddel, M; Remaley, Alan T.

doi:10.1016/s0009-9120(00)00141-7

Cited by 24 publications

(14 citation statements)

References 6 publications

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“…In highly experienced units, success rates can reach 90% or higher (108,587). Aids to successful cannulation include the use of CT scanning to localize the right adrenal vein prior to AVS (108,499) and "on-the-spot" plasma cortisol measurement which permits determination of adrenal venous cortisol levels within minutes of collection (326,575).…”

Section: F Adrenal Venous Samplingmentioning

confidence: 99%

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

Stowasser

Gordon

2016

Physiological Reviews

128

134

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In the 60 years that have passed since the discovery of the mineralocorticoid hormone aldosterone, much has been learned about its synthesis (both adrenal and extraadrenal), regulation (by renin-angiotensin II, potassium, adrenocorticotrophin, and other factors), and effects (on both epithelial and nonepithelial tissues). Once thought to be rare, primary aldosteronism (PA, in which aldosterone secretion by the adrenal is excessive and autonomous of its principal regulator, angiotensin II) is now known to be the most common specifically treatable and potentially curable form of hypertension, with most patients lacking the clinical feature of hypokalemia, the presence of which was previously considered to be necessary to warrant further efforts towards confirming a diagnosis of PA. This, and the appreciation that aldosterone excess leads to adverse cardiovascular, renal, central nervous, and psychological effects, that are at least partly independent of its effects on blood pressure, have had a profound influence on raising clinical and research interest in PA. Such research on patients with PA has, in turn, furthered knowledge regarding aldosterone synthesis, regulation, and effects. This review summarizes current progress in our understanding of the physiology of aldosterone, and towards defining the causes (including genetic bases), epidemiology, outcomes, and clinical approaches to diagnostic workup (including screening, diagnostic confirmation, and subtype differentiation) and treatment of PA.

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Section: F Adrenal Venous Samplingmentioning

confidence: 99%

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

Stowasser

Gordon

2016

Physiological Reviews

128

134

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“…In comparison with free peptide hormones, the effective half-lives for cortisol and testosterone when bound to their binding proteins are relatively long (16,64 ). Both of these hormones, however, have large concentration gradients in the venous blood draining the tissues that produce them, which can be used for localizing endocrine tumors.…”

Section: Other Rapid Intraoperative Immunoassaysmentioning

confidence: 99%

“…Both of these hormones, however, have large concentration gradients in the venous blood draining the tissues that produce them, which can be used for localizing endocrine tumors. For example, a rapid intraoperative cortisol assay has been used in the localization of aldosteronomas during catheterization procedures (16 ). Right adrenal vein catheterization is relatively easy to perform (65 ) because the right adrenal vein feeds directly into the large right renal vein.…”

Section: Other Rapid Intraoperative Immunoassaysmentioning

confidence: 99%

“…Typically, there is a Ͼ10-fold difference between the cortisol concentration in the adrenal vein sample vs a peripheral vein sample. Monitoring of cortisol during the catheterization procedure allows any improperly collected adrenal samples to be immediately recollected, thus reducing the frequency of repeat procedures (16 ).…”

Section: Other Rapid Intraoperative Immunoassaysmentioning

confidence: 99%

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Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

2004

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Background:The first description of the use of a rapid assay for the measurement of intact parathyroid hormone (PTH) in patients undergoing parathyroidectomy for hyperparathyroidism was reported in 1988. Subsequent improvements in the analytical performance of the rapid intraoperative PTH assay allowed the establishment of its clinical utility in the surgical management of hyperparathyroidism. These modifications also allowed the assay to be performed in or near the operating suite. Methods: We searched MEDLINE, using the following key words: intraoperative, rapid, quick, parathyroid hormone, hormone, and immunoassay. Relevant articles that focused on the analytical aspects and clinical utility of rapid intraoperative hormone immunoassays were selected for this review. Content: On the basis of the positive impact that the rapid intraoperative PTH test has had on both patient outcomes and cost savings, other rapid intraoperative hormone immunoassays for the diagnosis and/or treatment of other endocrine-hormone-secreting tumors have been developed. These hormones share certain characteristics that make them suitable for use as rapid intraoperative tests, i.e., short analyte half-life and/or large analyte concentration gradient, rapid analysis time, and positive clinical utility. Initial studies with cortisol, gastrin, insulin, adrenocorticotropic hormone, and testosterone have shown promising results in pre-

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“…Cure rates are quoted to be >95% [4]. A rapid intraoperative cortisol assay has been employed for patients with aldosteronomas [10,11]. To confirm that the serum sample during preoperative catheterization is certainly taken from the adrenal veins and to monitor the surgical success, intraoperative cortisol levels are additionally measured to aldosterone.…”

Section: Discussionmentioning

confidence: 99%

Fast Intraoperative Testosterone Assay Confirms the Location of an Ovarian Virilizing Tumor in a Young Girl

Braun

Peter²,

Warmann³

et al. 2012

Horm Res Paediatr

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The detection of testosterone-producing ovarian tumors in childhood and adolescence by imaging techniques only can be difficult because of the tumors' radiological structure and sometimes diminutive size. We describe an 11.5-year-old girl with a 9-month history of voice deepening, mild hirsutism, minor acne, increased growth velocity, weight gain, and clit-oromegaly. Laboratory investigation revealed an extremely elevated serum testosterone level without any additional endocrine abnormalities. Abdominal ultrasound and MRI showed a sparsely noticeable solid mass in the center of the right ovary. At laparotomy, blood was selectively drawn from the right and the left ovarian veins. Rapid testosterone measurement revealed a 70-fold higher testosterone concentration in the right ovarian vein within 45 min. Based on this finding, a right salpingo-oophorectomy was performed. The patient's postoperative testosterone level declined within 24 h. The histopathological diagnosis was Leydig cell tumor. In conclusion, the implementation of a fast intraoperative testosterone assay enabled the localization and curative therapy of a Leydig cell tumor. This technique seems to be a good alternative to preoperative selective venous blood sampling when body imaging does not unveil the tumor's site.

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Rapid intraoperative cortisol assay: design and utility for localizing adrenal tumors by venous sampling

Cited by 24 publications

References 6 publications

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

Fast Intraoperative Testosterone Assay Confirms the Location of an Ovarian Virilizing Tumor in a Young Girl

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