1. Corticotropin-releasing hormone test predicts the outcome of unilateral adrenalectomy in primary bilateral macronodular adrenal hyperplasia.
- Author
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Tizianel I, Detomas M, Deutschbein T, Fassnacht M, Albiger N, Iacobone M, Scaroni C, and Ceccato F
- Subjects
- Female, Humans, Middle Aged, Male, Corticotropin-Releasing Hormone, Hydrocortisone, Hyperplasia surgery, Retrospective Studies, Adrenocorticotropic Hormone, Adrenalectomy, Cushing Syndrome diagnosis, Cushing Syndrome etiology, Cushing Syndrome surgery
- Abstract
Purpose: Primary bilateral adrenal hyperplasia (PBMAH) is associated with hypercortisolism and a heterogeneous clinical expression in terms of cortisol secretion and related comorbidities. Historically, treatment of choice was bilateral adrenalectomy (B-Adx); however, recent data suggest that unilateral adrenalectomy (U-Adx) may be an effective alternative. For the latter, factors predicting the postsurgical outcome (e.g., biochemical control) have not been identified yet., Methods: PBMAH patients undergoing U-Adx for overt Cushing's syndrome (CS) in two tertiary care centers were retrospectively analysed. Remission was defined as a normalization of urinary free cortisol (UFC) without the need for medical treatment. The potential of hCRH test as a predictor of U-Adx outcome was evaluated in a subgroup., Results: 23 patients were evaluated (69% females, mean age 55 years). Remission rate after U-Adx was 74% at last follow up (median 115 months from UAdx). Before U-Adx, a positive ACTH response to hCRH (Δ%ACTH increase > 50% from baseline) was associated with higher remission rates., Conclusions: Three of four patients with PBMAH are surgically cured with U-Adx. Pre-operative hCRH testing can be useful to predict long-term remission rates., (© 2023. The Author(s).)
- Published
- 2024
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