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Adrenal venous sampling in a patient with adrenal Cushing syndrome.

Builes-Montaño CE, Villa-Franco CA, Román-Gonzalez A, Velez-Hoyos A, Echeverri-Isaza S - Colomb. Med. (2015)

Bottom Line: The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach.It could be a useful tool in this context because it might provide information to guide the treatment.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Médico Internista Endocrinólogo. Sección de Endocrinología, Departamento de Medicina Interna. Hospital Pablo Tobón Uribe - Universidad de Antioquia. Medellin, Colombia.

ABSTRACT
The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.

No MeSH data available.


Related in: MedlinePlus

Adrenal vein sampling. A: Right adrenal venography using 4Fr multipurpose catheter from femoral approach, where adrenal central vein can be seen right (black arrow) with glandular branches that converge to it. B: Left adrenal venography using multipurpose catheter 4Fr from femoral approach, where common adrenal trunk (black arrow) can be seen with the catheter in the interior, where the lower left phrenic vein (white arrow) and left adrenal vein (arrow without filler) converge.
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f02: Adrenal vein sampling. A: Right adrenal venography using 4Fr multipurpose catheter from femoral approach, where adrenal central vein can be seen right (black arrow) with glandular branches that converge to it. B: Left adrenal venography using multipurpose catheter 4Fr from femoral approach, where common adrenal trunk (black arrow) can be seen with the catheter in the interior, where the lower left phrenic vein (white arrow) and left adrenal vein (arrow without filler) converge.

Mentions: A previously described protocol was used 7 with some changes. The authors of the original protocol propose the measurement of epinephrine as a method to determine the proper location of the catheters when performing the sampling. Because we do not have readily available the measurement of plasma catecholamines the test was performed using radiographic documentation of the tip of the catheter and aldosterone levels were used to make the corrections in the dilution between both sides 2. Samples of both adrenal veins and inferior cava vein were taken (the procedure is shown in Figure 2 and the results are shown in Table 2). Based on the model of interpretation of adrenal venous sampling proposed by Young 3 the test suggest that the patient has an adrenal hyperplasia with predominance in the production of cortisol from the right side, the results were discussed with the patient and the surgical team and it was then decided to perform a bilateral adrenalectomy. The result of the histological study of the glands was consistent with a bilateral adrenal macronodular hyperplasia.


Adrenal venous sampling in a patient with adrenal Cushing syndrome.

Builes-Montaño CE, Villa-Franco CA, Román-Gonzalez A, Velez-Hoyos A, Echeverri-Isaza S - Colomb. Med. (2015)

Adrenal vein sampling. A: Right adrenal venography using 4Fr multipurpose catheter from femoral approach, where adrenal central vein can be seen right (black arrow) with glandular branches that converge to it. B: Left adrenal venography using multipurpose catheter 4Fr from femoral approach, where common adrenal trunk (black arrow) can be seen with the catheter in the interior, where the lower left phrenic vein (white arrow) and left adrenal vein (arrow without filler) converge.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4536821&req=5

f02: Adrenal vein sampling. A: Right adrenal venography using 4Fr multipurpose catheter from femoral approach, where adrenal central vein can be seen right (black arrow) with glandular branches that converge to it. B: Left adrenal venography using multipurpose catheter 4Fr from femoral approach, where common adrenal trunk (black arrow) can be seen with the catheter in the interior, where the lower left phrenic vein (white arrow) and left adrenal vein (arrow without filler) converge.
Mentions: A previously described protocol was used 7 with some changes. The authors of the original protocol propose the measurement of epinephrine as a method to determine the proper location of the catheters when performing the sampling. Because we do not have readily available the measurement of plasma catecholamines the test was performed using radiographic documentation of the tip of the catheter and aldosterone levels were used to make the corrections in the dilution between both sides 2. Samples of both adrenal veins and inferior cava vein were taken (the procedure is shown in Figure 2 and the results are shown in Table 2). Based on the model of interpretation of adrenal venous sampling proposed by Young 3 the test suggest that the patient has an adrenal hyperplasia with predominance in the production of cortisol from the right side, the results were discussed with the patient and the surgical team and it was then decided to perform a bilateral adrenalectomy. The result of the histological study of the glands was consistent with a bilateral adrenal macronodular hyperplasia.

Bottom Line: The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach.It could be a useful tool in this context because it might provide information to guide the treatment.Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Médico Internista Endocrinólogo. Sección de Endocrinología, Departamento de Medicina Interna. Hospital Pablo Tobón Uribe - Universidad de Antioquia. Medellin, Colombia.

ABSTRACT
The primary bilateral macronodular adrenal hyperplasia or the independent adrenocorticotropic hormone bilateral nodular adrenal hyperplasia is a rare cause hypercortisolism, its diagnosis is challenging and there is no clear way to decide the best therapeutic approach. Adrenal venous sampling is commonly used to distinguish the source of hormonal production in patients with primary hyperaldosteronism. It could be a useful tool in this context because it might provide information to guide the treatment. We report the case of a patient with ACTH independent Cushing syndrome in whom the use of adrenal venous sampling with some modifications radically modified the treatment and allowed the diagnosis of a macronodular adrenal hyperplasia.

No MeSH data available.


Related in: MedlinePlus