Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with bilateral adrenal masses

• Published in: Clinical endocrinology (Oxford) 2023-02, Vol.98 (2), p.177-189
• Main Authors: Johnson, Paige C., Thompson, Scott M., Adamo, Daniel, Fleming, Chad J., Bancos, Irina, McKenzie, Travis J., Cheville, John, Young, William F., Andrews, James C.
• Format: Article
• Language: English
• Subjects: Adrenal Gland Diseases; adrenal glands; Adrenal Glands - blood supply; adrenal venous sampling; Adrenalectomy; Adrenocorticotropic Hormone; Aldosterone; bilateral adrenal masses; Cortisol; cortisol lateralization Ratio; Cushing syndrome; Glucocorticoids; Hormones; Humans; Hydrocortisone; Hyperaldosteronism - surgery; mild autonomous cortisol secretion; Retrospective Studies; Sampling; Secretion; subclinical Cushing syndrome
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.14833

Objective The objective of this study was to evaluate the role of adrenal venous sampling (AVS) in guiding the management of patients with corticotropin (ACTH)‐independent glucocorticoid secretory autonomy and bilateral adrenal masses. Design and Patients A cohort with 25 patients underwent AVS and surgical management. Measurements Cortisol was measured from the adrenal veins (AVs) and inferior vena cava (IVC). AV/IVC cortisol ratio and cortisol lateralization ratio (CLR) (dominant AV cortisol concentration divided by the nondominant AV cortisol concentration) were calculated. Posthoc receiver‐operating characteristic curves were generated to determine the specificity of revised AV/IVC cortisol ratio and CLR in differentiating unilateral from bilateral disease. Results Patients underwent unilateral (n = 21) or bilateral (n = 4) adrenalectomy. The mean AV/IVC cortisol ratio for unilateral adrenalectomy was 12.1 ± 9.6 (dominant) and 4.7 ± 3.8 (contralateral) with a mean CLR of 3.6 ± 3.5. The mean AV/IVC cortisol ratio for bilateral adrenalectomy was 7.5 ± 2.1, with a mean CLR of 1.1 ± 0.6. At a mean follow‐up of 22 months, one patient who underwent unilateral adrenalectomy for the predicted bilateral disease developed recurrent mild autonomous cortisol secretion. Posthoc analyses demonstrated a specificity of 95%–100% for unilateral disease with AV/IVC cortisol ratio >9 for one side,  2.3. The specificity was 80%–90% for bilateral disease with AV/IVC cortisol ratio >5.1 bilaterally and a CLR