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Outcomes of Adrenal Venous Sampling in Patients with Bilateral Adrenal Masses and ACTH-Independent Cushing’s Syndrome
- Source :
- World Journal of Surgery. 43:527-533
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- Management of patients with bilateral adrenal masses and ACTH-independent Cushing’s syndrome (AICS) is challenging, as bilateral adrenalectomy can lead to steroid dependence and lifelong risk of adrenal crisis. Adrenal venous sampling (AVS) has been previously reported to facilitate lateralization for guiding adrenalectomy. The aim of the current study was to investigate the utility of AVS using protocol from study by Young et al. in the management of patients with bilateral adrenal masses and AICS. A retrospective review of all patients with bilateral adrenal masses and AICS who underwent AVS from 2008 to 2016 was performed. AVS for cortisol and epinephrine was performed with dexamethasone suppression. The adrenal vein to peripheral vein cortisol ratios and side-to-side cortisol lateralization ratios were calculated. AVS was successful in 8 of 9 patients. All 8 patients had AVS results indicating bilateral cortisol hypersecretion. Six patients underwent adrenalectomy: 3 had unilateral adrenalectomy of the larger size mass, 2 had bilateral adrenalectomy (both sides >4 cm.) and 1 had stepwise bilateral adrenalectomy. Final pathology revealed macronodular adrenal hyperplasia in all 6 patients that underwent surgery. AVS was useful in excluding a unilateral adenoma as the source of AICS in this study of patients with bilateral adrenal masses and AICS. However, adrenal mass size influenced surgical decision making more than AVS results. More data are needed before AVS can be advocated as essential for management of patients with bilateral adrenal masses and AICS.
- Subjects :
- Male
medicine.medical_specialty
Epinephrine
Hydrocortisone
Adenoma
medicine.medical_treatment
Adrenal Gland Neoplasms
Urology
Dexamethasone
Veins
03 medical and health sciences
0302 clinical medicine
Adrenal Glands
medicine
Humans
Vein
Cushing Syndrome
Aged
Retrospective Studies
business.industry
Adrenalectomy
Adrenal crisis
Middle Aged
medicine.disease
Cardiac surgery
medicine.anatomical_structure
030220 oncology & carcinogenesis
Macronodular Adrenal Hyperplasia
Female
030211 gastroenterology & hepatology
Surgery
medicine.symptom
business
Abdominal surgery
medicine.drug
Subjects
Details
- ISSN :
- 14322323 and 03642313
- Volume :
- 43
- Database :
- OpenAIRE
- Journal :
- World Journal of Surgery
- Accession number :
- edsair.doi.dedup.....2bce01c5666e9e4c4208c60ad32aa77d
- Full Text :
- https://doi.org/10.1007/s00268-018-4788-2