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Raje P, Broekhuis JM, Sacks BA, James BC. Diagnostic Impact of Adrenal Vein Sampling in Adrenal Cushing's Syndrome. J Surg Res 2021; 268:660-666. [PMID: 34481219 DOI: 10.1016/j.jss.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Adrenal Cushing's syndrome is characterized by ACTH-independent hypercortisolism. Adrenal vein sampling (AVS) is not routinely employed prior to management decisions, and few studies have investigated the value of AVS in this population. We assessed whether AVS provides a diagnostic benefit for treatment planning. MATERIALS AND METHODS Six patients with imaging and biochemical evidence of adrenal Cushing's syndrome undergoing AVS at our institution from 2015 to 2020 were analyzed retrospectively, including demographic and clinical characteristics. AVS lateralization index was determined by comparing the (cortisol/ipsilateral reference hormone) ratios of both adrenal veins. lateralization index of 2 or greater was considered diagnostic of unilateral disease. Post-management clinical improvement was defined as serum cortisol normalization, symptomatic improvement, or both. RESULTS Cross-sectional imaging noted bilateral adrenal enlargement or nodules in three patients, and unilateral nodules in three patients. AVS results were discordant with imaging in three patients. Treatment included medical management in two patients, percutaneous radiofrequency ablation in one patient, and laparoscopic adrenalectomy in two patients. One patient was lost to follow up. AVS results aided management planning in five patients, definitively changing treatment from surgery to medical management in one patient. All five patients demonstrated clinical improvement. CONCLUSIONS AVS offered useful information for determining appropriate management of adrenal Cushing's syndrome, especially distinguishing unilateral from bilateral disease. Even in bilateral disease, AVS may show a dominant gland, potentially allowing a staged unilateral adrenalectomy, before assessing the need for completion adrenalectomy or medical management. Larger studies are needed to better establish whether AVS offers significant benefit for this population.
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Affiliation(s)
- Praachi Raje
- Harvard Medical School, Boston, Massachusetts; Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jordan M Broekhuis
- Harvard Medical School, Boston, Massachusetts; Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Barry A Sacks
- Harvard Medical School, Boston, Massachusetts; Division of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Benjamin C James
- Harvard Medical School, Boston, Massachusetts; Section of Endocrine Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Becker LS, Hinrichs MH, Werncke T, Dewald CLA, Maschke SK, Limbourg FP, Ringe KI, Hinrichs JB, Wacker F, Meyer BC. Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C-arm CT findings. Abdom Radiol (NY) 2021; 46:3471-3481. [PMID: 33674958 PMCID: PMC8215038 DOI: 10.1007/s00261-021-03003-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the feasibility and effect of an approach to adrenal venous sampling (AVS) analysis by combining established selective cortisol and aldosterone indices with the acquisition of a collimated C-arm CT(CACTColl). METHODS Overall, 107 consecutive patients (45f,62 m; 54 ± 10 years) undergoing 111 AVS procedures without hormonal stimulation from 7/13 to 2/20 in a single institution were retrospectively analysed. Hormone levels were measured in sequential samples of the suspected adrenal veins and right iliac vein, and selectivity indices (SI) computed. Stand-alone SICortisol and/or SIAldosterone ≥ 2.0 as well as SICortisol and/or SIAldosterone ≥ 1.1 combined with positive right-sided CACTColl of the adrenals (n = 80; opacified right adrenal vein) were defined as a successful AVS procedure. Radiation exposure of CACT was measured via dose area product (DAP) and weighed against an age-/weight-matched cohort (n = 66). RESULTS Preliminary success rates (SICortisol and/or SIAldosterone ≥ 2.0) were 99.1% (left) and 72.1% (right). These could be significantly increased to a 90.1% success rate on the right, by combining an adjusted SI of 1.1 with a positive CACTColl proving the correct sampling position. Sensitivity for stand-alone collimated CACT (CACTColl) was 0.93, with 74/80 acquired CACTColl confirming selective cannulation by adrenal vein enhancement. Mean DAPColl_CACT measured 2414 ± 958 μGyxm2, while mean DAPFull-FOV_CACT in the matched cohort measured 8766 ± 1956 μGyxm2 (p < 0.001). CONCLUSION Collimated CACT in AVS procedures is feasible and leads to a significant increase in success rates of (right-sided) selective cannulation and may in combination with adapted hormone indices, offer a successful alternative to previously published AVS analysis algorithms with lower radiation exposure compared to a full-FOV CACT.
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Affiliation(s)
- L S Becker
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - M H Hinrichs
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - T Werncke
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - C L A Dewald
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - S K Maschke
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F P Limbourg
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - K I Ringe
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - J B Hinrichs
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - F Wacker
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - B C Meyer
- Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, Hannover Medical School, OE8220, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Tan MO, Puar THK, Swaminathan SK, Tay YKD, Aw TC, Lim DY, Shi H, Dacay LMQ, Zhang M, Khoo JJC, Ng KS. Improved adrenal vein sampling from a dedicated programme: experience of a low-volume single centre in Singapore. Singapore Med J 2020; 63:111-116. [PMID: 33264832 DOI: 10.11622/smedj.2020171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Min-On Tan
- Department of Radiology, Changi General Hospital, Singapore
| | | | - Saravana Kumar Swaminathan
- Department of Radiology, Changi General Hospital, Singapore.,Department of Neuroradiology, National Neuroscience Institute, Singapore
| | | | - Tar Choon Aw
- Laboratory Medicine, Changi General Hospital, Singapore
| | | | - Haiyuan Shi
- Department of Radiology, Changi General Hospital, Singapore
| | | | - Meifen Zhang
- Department of Endocrinology, Changi General Hospital, Singapore.,William Harvey Research Institute, Queen Mary University of London, London, England, United Kingdom
| | | | - Keng Sin Ng
- Department of Radiology, Changi General Hospital, Singapore.,Mount Alvernia Hospital, Singapore
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Ierardi AM, Petrillo M, Patella F, Biondetti P, Fumarola EM, Angileri SA, Pesapane F, Pinto A, Dionigi G, Carrafiello G. Interventional radiology of the adrenal glands: current status. Gland Surg 2018; 7:147-165. [PMID: 29770310 DOI: 10.21037/gs.2018.01.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As more and more adrenal neoplasms are found incidentally or symptomatically, the need for interventional procedures has being increasing. In recent years these procedures registered continued steady expansion. Interventional radiology of the adrenal glands comprises angiographic and percutaneous procedures. They may be applied both in benign and in malignant pathologies. The present review reports the current status of indications, techniques results and complications of the image-guided procedures.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Mario Petrillo
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Patella
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pierpaolo Biondetti
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Filippo Pesapane
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Gianlorenzo Dionigi
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital, Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Intervention Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
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Lima-Oliveira G, Lippi G, Salvagno GL, Gelati M, Bassi A, Contro A, Pizzolo F, Guidi GC. Abnormal gel flotation caused by contrast media during adrenal vein sampling. Biochem Med (Zagreb) 2016; 26:444-450. [PMID: 27812311 PMCID: PMC5082217 DOI: 10.11613/bm.2016.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/13/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION During adrenal venous sampling (AVS) procedure, radiologists administer a contrast agent via the catheter to visualize the proper catheter position. MATERIALS AND METHODS A patient with primary aldosteronism diagnostic-hypothesis was admitted for AVS. A venogram was performed to
confirm the catheter's position with 2mL of Iopamidol 300 mg/mL. Samples were collected with syringe connected to a hydrophilic coated catheter by low-pressure aspiration from each of the four collection sites: inferior vena cava in the suprarenal portion, inferior vena cava in the infrarenal portion, left adrenal vein, and right adrenal vein; then immediately transferred from syringe to tubes with gel separator. All tubes were centrifuged at 1200 x g for 10 minutes. RESULTS At the end of centrifugation process, primary blood tubes containing blood from inferior vena cava and left adrenal vein exhibited the standard gel separator barrier, while tubes from right adrenal vein showed abnormal flotation of gel separator. The radiologist confirmed the usage of 2.6 mL instead of 2.0 mL of Iopamidol 300 mg/mL. This iodinated contrast media, with 1.33 g/cm3 of density, was used close to the right adrenal vein due to some difficulty to access it. CONCLUSION The abnormal flotation of gel separator in samples taken from right adrenal vein can be explained by the usage of the iodinated
contrast media. We suggest using plain-tubes (without gel separator) for AVS in order to avoid preanalytical nonconformities. Moreover, a blood volume equivalent to twice the catheter extension should be discarded to eliminate residual contrast media before collection of samples for laboratory assays.
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Affiliation(s)
- Gabriel Lima-Oliveira
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
| | - Gian Luca Salvagno
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Matteo Gelati
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Antonella Bassi
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Alberto Contro
- Vascular Interventional Radiology Unit, Institute of Radiology, University of Verona, Italy
| | - Francesca Pizzolo
- Division of Internal Medicine, Department of Medicine, University of Verona, Italy
| | - Gian Cesare Guidi
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
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