Discordance between adrenal vein sampling and imaging: the role of unilateral cortisol excess
Authors' conclusion
Discordant CT and AVS results in patients with PA and obvious adrenal mass are often explained by subclinical asymmetric cortisol excess. Clinicians should be aware of the limitations of AVS in the presence of subtle autonomous cortisol secretion and must be able to counsel patients regarding the possible outcomes from surgery when discordant lateralization is present.
Study context
- Population
- Patients in Calgary, Alberta with primary aldosteronism (PA) and clear adrenal mass, discordant adrenal vein sampling (AVS) and cross-sectional imaging, who underwent dexamethasone-suppressed NP59-iodocholesterol adrenal scintigraphy
- Participants
- 25 patients
- Outcome
- NP59 autonomous steroidogenesis from same side as CT-identified lesion despite discordant AVS
Methodological detailssingle-group descriptive, Surgical pathology analyzed with immunohistochemical staining for CYP11B1 and CYP11B2
- Single-group descriptive
- Surgical pathology analyzed with immunohistochemical staining for CYP11B1 and CYP11B2
Main finding
As reported in the abstract
Cases with NP59 lateralization concordant with computed tomography (CT) lesion
19 of 25
Observational data: associations, not effects.
Further findings
Final diagnosis after NP59-guided adrenalectomy
- Underwent adrenalectomy
- 16
- Cortisol-producing adenoma with bilateral PA
- 11
- Cortisol-producing adenoma with unilateral PA (complete biochemical response)
- 5
ACTH · pre- and postadrenalectomy
- All cases had low/suppressed ACTH preoperatively that rose postadrenalectomy, consistent with resolution of cortisol autonomy
AVS incorrectly diagnosed PA subtype or falsely localized side of aldosterone excess
- Cases misdiagnosed or mislocalized by AVS
- 10/16
Original publication
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