The clinical conundrum of corticotropin-independent autonomous cortisol secretion in patients with bilateral adrenal masses
The clinical conundrum of corticotropin-independent autonomous cortisol secretion in patients with bilateral adrenal masses
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DOI：
10.1007/s00268-007-9332-8
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发表时间：
2008-05-01
影响因子：
2.6
通讯作者：
Carpenter, Paul C.
中科院分区：
文献类型：
--
作者：
Young, William F., Jr.;Du Plessis, Hendrick;Carpenter, Paul C.
双侧肾上腺肿块伴促肾上腺皮质激素（ACTH）非依赖性库欣综合征（CS）或亚临床CS患者的治疗存在问题。我们报告我们的经验与肾上腺静脉采样（AVS）在10例双侧肿块谁有ACTH非依赖性CS或亚临床CS.Patients和方法10例（9名女性，1名男性，平均年龄56.4岁）与双侧肾上腺肿块和ACTH非依赖性CS（n = 3）或亚临床CS（n = 7）进行AVS的评价。自主皮质醇分泌记录在所有情况下，抑制血清促肾上腺皮质激素浓度和缺乏皮质醇抑制地塞米松管理。在地塞米松给药的第二天进行肾上腺静脉采样。肾上腺皮质醇和肾上腺素水平从每个肾上腺静脉（AV）和外周静脉（PV）进行了测量。结果平均（+/- SD）的肾上腺肿块的最大直径的计算机断层扫描为3.3 +/- 1.3 cm（范围：1.2-6.0 cm）。通过AV：PV肾上腺素梯度确认导管插入成功。皮质醇AV：PV梯度> 6.5与11例肾上腺皮质醇分泌腺瘤一致; 5例患者有临床重要的双侧自主性皮质醇分泌过多，3例有双侧皮质醇分泌腺瘤，2例有ACTH非依赖性肾上腺大结节增生。所有10例患者均完成了肾上腺静脉取样引导的肾上腺切除术-2例患者行双侧肾上腺全切除术，另2例患者行双侧肾上腺次全切除术。在平均随访36.1个月（范围：0.7-123个月），CS或临床上重要的皮质醇分泌自主性没有recur.Conclusions肾上腺静脉采样有助于自主性皮质醇增多症的ACTH独立CS或亚临床CS患者双侧肾上腺肿块的设置本地化。
Background Management of patients with bilateral adrenal masses and corticotropin (ACTH)-independent Cushing syndrome (CS) or subclinical CS is problematic. We report our experience with adrenal venous sampling (AVS) in the evaluation of 10 patients with bilateral masses who had ACTH-independent CS or subclinical CS.Patients and Methods Ten patients (9 women, 1 man, mean age 56.4 years) with bilateral adrenal masses and ACTH-independent CS (n = 3) or subclinical CS (n = 7) underwent AVS. Autonomous cortisol secretion was documented in all cases with suppressed serum ACTH concentrations and lack of cortisol suppression with dexamethasone administration. Adrenal venous sampling was performed on the second day of dexamethasone administration. Cortisol and epinephrine levels were measured from each adrenal vein (AV) and from a peripheral vein (PV).Results Mean (+/- SD) maximal diameter of the adrenal masses on computed tomography was 3.3 +/- 1.3 cm (range: 1.2-6.0 cm). Successful catheterization was confirmed with AV:PV epinephrine gradients. A cortisol AV:PV gradient > 6.5 was consistent with a cortisol-secreting adenoma in 11 adrenal glands; 5 patients had clinically important bilateral autonomous cortisol hypersecretion, 3 had bilateral cortisol-secreting adenomas, and 2 had ACTH-independent macronodular adrenal hyperplasia. Adrenal venous sampling-guided adrenalectomy was completed in all 10 patients-2 patients had total bilateral adrenalectomy and 2 others had subtotal bilateral adrenalectomy. During a mean follow-up of 36.1 months (range: 0.7-123 months), CS or clinically important cortisol secretory autonomy did not recur.Conclusions Adrenal venous sampling contributed to the localization of autonomous hypercortisolism in the setting of ACTH-independent CS or subclinical CS in patients with bilateral adrenal masses.