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Adrenal venous sampling in patients with ACTH-independent hypercortisolism

Artikel i vetenskaplig tidskrift
Författare Eleni Papakokkinou
Hugo Jakobsson
Augustinas Sakinis
Andreas Muth
Bo Wängberg
Olof Ehn
Gudmundur Johannsson
Oskar Ragnarsson
Publicerad i Endocrine
Volym 66
Nummer/häfte 2
Sidor 338–348
ISSN 1355-008X
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för kirurgi
Institutionen för medicin, avdelningen för invärtesmedicin och klinisk nutrition
Sidor 338–348
Språk en
Länkar https://doi.org/10.1007/s12020-019-...
Ämnesord ACTH-independent, Adrenal venous sampling, Autonomous cortisol secretion, Cushing’s syndrome, Hypercortisolism
Ämneskategorier Endokrinologi

Sammanfattning

© 2019, The Author(s). Purpose: To 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. Methods: A 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. Results: Four 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. Conclusions: AVS 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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