Uso del muestreo venoso adrenal en un paciente con un síndrome de Cushing adrenal

Builes, Carlos; Villa-Franco, Carlos Andrés; Román-Gonzaléz, Alejandro; Vélez-Hoyos, Alejandro; Echeverri-Isaza, Santiago

doi:10.25100/cm.v46i2.1938

Cited by 12 publications

(10 citation statements)

References 10 publications

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“…The interpretation of adequate catheterization varies as well. In one report the radiographic localization of the catheter tip during collection of the adrenal samples was used [12]. In other reports measurements of noradrenaline and adrenaline [13], or only adrenaline [10, 16], were used for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

et al. 2019

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PurposeTo study the usefulness of adrenal venous sampling (AVS) in distinguishing unilateral from bilateral cortisol production in patients with ACTH-independent hypercortisolism and bilateral adrenal lesions, or morphologically normal adrenal glands.MethodsA retrospective analysis of ten consecutive patients with ACTH-independent hypercortisolism who underwent AVS at our institution between 2009 and 2017. Unilateral dominant cortisol production was defined as a side-to-side cortisol/aldosterone lateralization ratio >2.ResultsFour of ten patients had overt Cushing’s syndrome. Of these, two had bilateral adrenal lesions on computed tomography and two had normal adrenal glands. One of the two patients with bilateral adrenal lesions had, based on the AVS, a unilateral dominant cortisol production. Following unilateral adrenalectomy the patient developed adrenal insufficiency. The other three patients were considered to have bilateral cortisol production and underwent bilateral adrenalectomy. Six patients had a mild autonomous cortisol secretion and bilateral adrenal lesions. Based on AVS, one patient was considered to have unilateral dominant cortisol production, underwent unilateral adrenalectomy and developed transient adrenal insufficiency postoperatively.ConclusionsAVS may contribute to appropriate treatment in patients with ACTH-independent hypercortisolism and bilateral adrenal lesions. In our series, AVS was helpful in the decision-making of two out of ten patients, avoiding chronic treatment with steroidogenesis inhibitors, or inappropriate bilateral adrenalectomy.

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Section: Discussionmentioning

confidence: 99%

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

et al. 2019

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“…In PA patients, “cortisol-corrected” aldosterone ratios are compared to determine whether a unilateral source of aldosterone exists. Previous studies attempted to use epinephrine or aldosterone to correct for the side-to-side cortisol gradient [7–9]. Based on the data of Freel EM et al, in patients without pheochromocytoma, a gradient in catecholamine production between the right and left adrenal glands can be a normal finding.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, it is predictable that the use of aldosterone might correct for the cortisol lateralization ratio caused by the dilutional effect but not by stress or fluctuation of ACTH. Thus, it is not surprising that the diagnosis by AVS in two cases proved to be incorrect in patients with bilateral adrenal masses and ACTH-independent CS [8, 9].…”

Section: Discussionmentioning

confidence: 99%

The Value of Adrenal Androgens for Correcting Cortisol Lateralization in Adrenal Venous Sampling in Patients with Normal Cortisol Secretion

Zhang

Zhu

Liu

et al. 2019

International Journal of Endocrinology

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The management of patients with adrenocorticotropic hormone-independent Cushing’s syndrome and bilateral adrenal masses is challenging. Adrenal venous sampling (AVS) has been used to identify functional lesions in previous studies, but it is not always reliable. The present study aims to address the variability of cortisol in the adrenal veins of patients without excessive cortisol secretion and investigate the use of adrenal androgens to correct the cortisol lateralization ratio in AVS. Thirty-seven patients with primary aldosteronism underwent successful AVS. Patients with normal cortisol secretion exhibited a wide range of cortisol concentrations in the right (601-89, 400 nmol/l) and left (331-35, 300 nmol/l) adrenal veins. The median cortisol gradients between adrenal venous and peripheral venous samples were 15.25 and 10.14 in the right and left sides, respectively, and the cortisol lateralization ratio (high side to low side) was as high as 9.49 (median 1.54). The mean plasma levels of cortisol in the adrenal venous and peripheral venous samples decreased from t-15 to t0. Significant positive correlations were observed between the cortisol concentrations and both androstenedione and dehydroepiandrosterone concentrations in the right and left adrenal veins. After correcting for androstenedione or dehydroepiandrosterone levels, the cortisol lateralization ratio was less than 2 in most adrenal venous samples. The present study demonstrated the wide variation in cortisol concentrations in the adrenal veins of patients with normal cortisol secretion. The adrenal androgens might be ideal analytes used as normalizers when assessing the cortisol lateralization of AVS in normal or hypercortisolism cases.

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“…Estudios de imagen, su finalidad es confirmar las alteraciones, que constituyan el origen del trastorno bioquímico [2]; si la sospecha es suprarrenal, el estudio de elección es la tomografía computarizada (TC) o resonancia magnética de abdomen con contraste, buscando masas o hiperplasia en adrenal [8]. Una alternativa es el muestreo venoso adrenal mediante radiología intervencionista, esta estrategia es de gran ayuda en caso de adenomas bilaterales, dado que se puede identificar la glándula responsable y programar su extracción quirúrgica, dejando preservada la glándula contralateral [12].…”

Section: Enfoque Diagnósticounclassified

“…Si la sospecha es hipofisaria, se debe realizar una resonancia magnética cerebral, en busca de masa hipofisiario, el 90% de los tumores pituitarios secretores de ACTH son microadenomas, una lesión mayor de 6 mm sumado a test positivos para origen hipofisario, hacen el diagnóstico de enfermedad de Cushing [3,8,12,13].…”

Section: Enfoque Diagnósticounclassified

Presentación de tres casos y revisión en la literatura: Síndrome de Cushing

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Botina²,

Sánchez³

et al. 2017

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El hipercortisolismo es una enfermedad rara, con afección de múltiples sistemas, asociada a elevada morbilidad y mortalidad sino es tratada a tiempo. El sistema cardiovascular es uno de los que más se afecta en esta enfermedad. El pronóstico de la enfermedad se ve afectado principalmente por las dificultades en el diagnóstico y el tratamiento, los cuales siguen siendo un desafío actualmente. El síndrome de Cushing se clasifica como dependiente o independiente de hormona adrenocorticotrópica (ACTH). Los ACTH dependientes son los más comunes. Los ACTH independientes corresponden a menos de 15% de los casos y son causados por enfermedades suprarrenales. A continuación, describimos los casos de los tres pacientes, a quienes se les estableció el diagnóstico de síndrome de Cushing de origen adrenal y se realiza una revisión acerca de los tópicos principales en este tema.

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Uso del muestreo venoso adrenal en un paciente con un síndrome de Cushing adrenal

Cited by 12 publications

References 10 publications

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

The Value of Adrenal Androgens for Correcting Cortisol Lateralization in Adrenal Venous Sampling in Patients with Normal Cortisol Secretion

Presentación de tres casos y revisión en la literatura: Síndrome de Cushing

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