Adrenal Venous Sampling for Assessment of Autonomous Cortisol Secretion

Context Autonomous cortisol secretion (ACS) can be unilateral or bilateral irrespective of the presence of an adrenal tumor. A reliable method to distinguish between unilateral and bilateral ACS is lacking. Objective Evaluate the use of adrenal venous sampling (AVS) to distinguish between unilateral and bilateral ACS. Design and Methods This was a prospective study of AVS in patients with adrenal tumors who received a diagnosis of ACS or adrenal Cushing syndrome (CS). Unilateral secretion was defined as >2.3-fold difference in cortisol levels between the two adrenal veins. Metanephrine levels were used to ascertain correct catheter position. Results were correlated with findings on CT and iodine-131-cholesterol scintigraphy. Results Thirty-nine patients underwent AVS; there were no complications. The procedure was inconclusive in six patients and repeated with success in one, giving a success rate of 85%, and leaving 34 procedures for evaluation (adrenal CS, n = 2; ACS, n = 32). Of 14 patients with bilateral tumors, 10 had bilateral and 4 had unilateral overproduction. Of 20 patients with unilateral tumors, 11 had lateralization to the side of the tumor and the remaining had bilateral secretion. Cholesterol scintigraphy findings were concordant with those of AVS in 13 of 18 cases (72%) and discordant in 5 (28%). Conclusion Laterality of ACS does not always correspond to findings on CT images. AVS is a safe and valuable tool for differentiation between unilateral and bilateral cortisol secretion and should be considered when operative treatment of ACS is a possibility.

• Publication year

  2018

• Venue

  Journal of Clinical Endocrinology and Metabolism

• Publication date

  2018-08-20

• Fields of study

  Medicine

• Identifiers
  DOI 10.1210/jc.2018-01198PMID 30137397
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• The Short Cosyntropin Test Revisited: New Normal Reference Range Using LC-MS/MS

  2018cited by this paper
• Simultaneous assay of cortisol and dexamethasone improved diagnostic accuracy of the dexamethasone suppression test.

  2017cited by this paper
• The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline.

  2016cited by this paper
• Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors.

  2016cited by this paper
• Contralateral adrenal suppression on adrenocortical scintigraphy provides good evidence showing subclinical cortisol overproduction from unilateral adenomas.

  2016cited by this paper
• Adrenal Venous Sampling Is Useful for a Definitive Diagnosis in Cushing's Syndrome with Bilateral Adrenal Tumors.

  2016cited by this paper
• A case of adrenal Cushing’s syndrome with bilateral adrenal masses

  2016cited by this paper
• Adrenal venous sampling in a patient with adrenal Cushing syndrome

  2015cited by this paper
• Adrenal 131I-6β-iodomethylnorcholesterol scintigraphy in choosing the side for adrenalectomy in bilateral adrenal tumors with subclinical hypercortisolemia

  2015cited by this paper
• The Role of Adrenal Scintigraphy in the Diagnosis of Subclinical Cushing’s Syndrome and the Prediction of Post-surgical Hypoadrenalism

  2014cited by this paper
• Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism.

  2014cited by this paper
• Adrenal venous catecholamine concentrations in patients with adrenal masses other than pheochromocytoma

  2013cited by this paper
• Multisteroid LC–MS/MS assay for glucocorticoids and androgens and its application in Addison's disease

  2013cited by this paper
• Plasma Metanephrine for Assessing the Selectivity of Adrenal Venous Sampling

  2013cited by this paper
• Subclinical Cushing’s syndrome: definition and management

  2012cited by this paper
• Adrenal Cortical Imaging With I-131 NP-59 SPECT-CT

  2010cited by this paper
• The Clinical Conundrum of Corticotropin-independent Autonomous Cortisol Secretion in Patients with Bilateral Adrenal Masses

  2008cited by this paper
• Roles of clinical criteria, computed tomography scan, and adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes.

  2008cited by this paper
• Quantitative evaluation of norcholesterol scintigraphy, CT attenuation value, and chemical-shift MR imaging for characterizing adrenal adenomas

  2008cited by this paper
• Role for adrenal venous sampling in primary aldosteronism.

  2004cited by this paper
• Scintigraphic patterns of adrenocortical carcinoma: morpho-functional correlates.

  2001cited by this paper
• A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology.

  2000cited by this paper
• A Survey on Adrenal Incidentaloma in Italy

  2000cited by this paper

• Effect of surgical versus conservative management on cardiovascular outcomes in patients with bilateral adrenal tumours and cortisol excess: an international, retrospective cohort study.

  2026cites this paper
• Improved and individualized approach to adrenal surgery.

  2025cites this paper
• BILATERAL ADRENAL NODULES PRESENTING WITH MILD AUTONOMOUS CORTISOL SECRETION.

  2025cites this paper
• Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline.

  2025cites this paper
• An Analysis of Post-Adrenalectomy Dynamics in MACS (Mild Autonomous Cortisol Secretion)-Positive Adrenal Tumours: The Biomarkers and Clinical Impact

  2025cites this paper
• Update of the guidelines on the management of adrenal incidentaloma from the adrenal group of the Spanish society of endocrinology and nutrition (SEEN)

  2025cites this paper
• Addressing the Clinical Conundrum of Localization in ACTH-independent Cushing Syndrome With Bilateral Adrenal Nodules

  2025influential citation
• Selective venous sampling for secondary hypertension

  2024cites this paper
• Adrenal Vein Sampling for Primary Aldosteronism: Recommendations From the Australian and New Zealand Working Group

  2024cites this paper
• Challenging Diagnostic Workup of a 22-year-old Patient With Primary Pigmented Nodular Adrenocortical Disease

  2024cites this paper
• Bilateral Adrenocortical Nodular Disease and Cushing's Syndrome.

  2024cites this paper
• Mild autonomous cortisol secretion: pathophysiology, comorbidities and management approaches

  2024cites this paper
• Adrenal Vein Sampling: Does the Location of the Non-adrenal Venous Sample Matter?

  2024cites this paper
• Experience in the treatment of patients with ACTH-independent macronodular bilateral adrenal hyperplasia

  2023cites this paper
• European Society of Endocrinology Clinical Practice Guidelines on the management of adrenal incidentalomas, in collaboration with the European Network for the Study of Adrenal Tumors.

  2023cites this paper
• Adrenal Vein Sampling in the Management of Primary Aldosteronism: The Added Value of Intraprocedural Cortisol Assessment

  2023cites this paper
• Il cateterismo delle vene surrenaliche nella diagnostica delle sindromi di Cushing

  2023cites this paper
• The Entity of Connshing Syndrome: Primary Aldosteronism with Autonomous Cortisol Secretion

  2022cites this paper
• Eleven-Year Experience with Selective Adrenal Vein Sampling in Management of Primary Adrenal Hormonal Hypersecretion

  2022cites this paper
• Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with bilateral adrenal masses

  2022influential citation
• The role of adrenal venous sampling (AVS) in primary bilateral macronodular adrenocortical hyperplasia (PBMAH): a study of 16 patients

  2022cites this paper
• Steroid profiling using liquid chromatography mass spectrometry during adrenal vein sampling in patients with primary bilateral macronodular adrenocortical hyperplasia

  2022cites this paper
• Follow-up of second adrenal tumor after remission of Cushing syndrome

  2021cites this paper
• Disorders of the adrenal gland

  2021cites this paper
• Role of unilateral adrenalectomy in bilateral adrenal hyperplasias with Cushing's syndrome.

  2021cites this paper
• Adrenal Vein Cortisol to Metanephrine Ratio for Localizing ACTH-Independent Cortisol-Producing Adenoma: A Case Report.

  2021influential citation
• Management of the patient with incidental bilateral adrenal nodules

  2021cites this paper
• Approach to the patient with adrenal incidentaloma.

  2021cites this paper
• Diagnostic Impact of Adrenal Vein Sampling in Adrenal Cushing's Syndrome.

  2021cites this paper
• Bilateral Adrenal Hyperplasia: Pathogenesis and Treatment

  2021cites this paper
• DMSO_A_262092 3519..3525

  2020cites this paper
• Guideline

  2020cites this paper
• Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance Update: Selektive Nebennierenvenenblutentnahme (NNVBE) – Indikation, Technik und Stellenwert

  2020cites this paper
• Repeat adrenal vein sampling in aldosteronism: reproducibility and interpretation of persistently discordant results.

  2020cites this paper
• Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy

  2020cites this paper
• Imaging of Adrenal-Related Endocrine Disorders.

  2020cites this paper
• Approach to the Patient with Subclinical Cushing's Syndrome.

  2020cites this paper
• Approach to patients with bilateral adrenal incidentalomas.

  2020cites this paper
• Advances in the Diagnosis and Medical Management of Cushing's Syndrome

  2020cites this paper
• THE EVALUATION OF INCIDENTALLY DISCOVERED ADRENAL MASSES.

  2019cites this paper
• Modern Management of Mild Autonomous Cortisol Secretion

  2019influential citation
• Surgical Approach to Endocrine Hypertension in Patients with Adrenal Disorders.

  2019cites this paper
• Adrenal Imaging in Patients with Endocrine Hypertension.

  2019cites this paper
• Diagnosis and management of primary bilateral macronodular adrenal hyperplasia

  2019cites this paper
• Unilateral adrenalectomy in primary bilateral macronodular hyperplasia

  2019cites this paper
• Adrenal venous sampling in patients with ACTH-independent hypercortisolism

  2019cites this paper
• Adrenal vein sampling: How i do it

  2019cites this paper