PMID- 30232569
OWN - NLM
STAT- MEDLINE
DCOM- 20190626
LR  - 20200225
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 43
IP  - 2
DP  - 2019 Feb
TI  - Outcomes of Adrenal Venous Sampling in Patients with Bilateral Adrenal Masses and 
      ACTH-Independent Cushing's Syndrome.
PG  - 527-533
LID - 10.1007/s00268-018-4788-2 [doi]
AB  - BACKGROUND: 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. METHODS AND 
      DESIGN: 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. RESULTS: 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. CONCLUSION: 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.
FAU - Acharya, Runa
AU  - Acharya R
AD  - Department of Medicine, Division of Endocrinology and Metabolism, SUNY Upstate 
      Medical University, Syracuse, NY, USA.
FAU - Dhir, Mashaal
AU  - Dhir M
AD  - Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.
FAU - Bandi, Rupal
AU  - Bandi R
AD  - Department of Radiology, Division of Interventional Radiology, University of 
      Pittsburgh, Pittsburgh, PA, USA.
FAU - Yip, Linwah
AU  - Yip L
AD  - Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, 
      Pittsburgh, PA, USA.
FAU - Challinor, Sue
AU  - Challinor S
AD  - Department of Medicine, Division of Endocrinology and Metabolism, University of 
      Pittsburgh, Pittsburgh, PA, USA. suc3@pitt.edu.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
RN  - 7S5I7G3JQL (Dexamethasone)
RN  - WI4X0X7BPJ (Hydrocortisone)
RN  - YKH834O4BH (Epinephrine)
RN  - Acth-Independent Macronodular Adrenal Hyperplasia
SB  - IM
MH  - Adrenal Gland Neoplasms/blood/*surgery
MH  - Adrenal Glands/blood supply
MH  - Adrenalectomy/*methods
MH  - Aged
MH  - Cushing Syndrome/blood/*surgery
MH  - Dexamethasone/pharmacology
MH  - Epinephrine/*blood
MH  - Female
MH  - Humans
MH  - Hydrocortisone/*blood
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Veins
EDAT- 2018/09/21 06:00
MHDA- 2019/06/27 06:00
CRDT- 2018/09/21 06:00
PHST- 2018/09/21 06:00 [pubmed]
PHST- 2019/06/27 06:00 [medline]
PHST- 2018/09/21 06:00 [entrez]
AID - 10.1007/s00268-018-4788-2 [pii]
AID - 10.1007/s00268-018-4788-2 [doi]
PST - ppublish
SO  - World J Surg. 2019 Feb;43(2):527-533. doi: 10.1007/s00268-018-4788-2.