Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with bilateral adrenal masses
Authors' conclusion
Among patients with bilateral adrenal masses and ACTH-independent autonomous cortisol secretion, AVS can distinguish between unilateral and bilateral disease with high specificity and may guide surgical management.
Study context
- Population
- Patients with ACTH-independent glucocorticoid secretory autonomy and bilateral adrenal masses who underwent adrenal venous sampling (AVS) and surgery
- Participants
- 25 patients
- Exposure
- Unilateral vs bilateral adrenalectomy guided by AVS
- Unilateraln = 21
- Bilateraln = 4
- Outcome
- AV/IVC cortisol ratio and cortisol lateralization ratio (CLR)
Methodological detailspost hoc ROC analysis
- Post hoc ROC analysis
Main finding
As reported in the abstract
| Group | Value | AV/inferior vena cava (IVC) cortisol ratio, contralateral (mean ± ) | Cortisol lateralization ratio (CLR) (mean ±) |
|---|---|---|---|
| Unilateral | mean 12.1 ± 9.6 | 4.7 ± 3.8 | 3.6 ± 3.5 |
| Bilateral | mean 7.5 ± 2.1 | 1.1 ± 0.6 |
Value
Unilateralmean 12.1 ± 9.6
Bilateralmean 7.5 ± 2.1
AV/inferior vena cava (IVC) cortisol ratio, contralateral (mean ± )
Unilateral4.7 ± 3.8
Bilateral— not stated in the abstract
Cortisol lateralization ratio (CLR) (mean ±)
Unilateral3.6 ± 3.5
Bilateral1.1 ± 0.6
Observational data: associations, not effects.
Further findings
Specificity of AVS criteria (post hoc ROC)
- Specificity for unilateral disease (AV/IVC ratio >9 one side, <2.0 opposite side, CLR > 2.3)
- 95%-100%
- Specificity for bilateral disease (AV/IVC ratio >5.1 bilaterally, CLR < 1.1)
- 80%-90%
- Posthoc analyses
Recurrent mild autonomous cortisol secretion · mean follow-up 22 months
- Recurrence after unilateral adrenalectomy for predicted bilateral disease
- 1 patient
Original publication
Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with bilateral adrenal masses. Clin Endocrinol (Oxf). Published 1 November 2022. doi:10.
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