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. 2023 Feb;98(2):177-189.
doi: 10.1111/cen.14833. Epub 2022 Nov 1.

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

Paige C Johnson  1 , Scott M Thompson  1 , Daniel Adamo  1 , Chad J Fleming  1 , Irina Bancos  2 , Travis J McKenzie  3 , John Cheville  4 , William F Young  2 , James C Andrews  1
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Adrenal venous sampling for lateralization of cortisol hypersecretion in patients with bilateral adrenal masses

Paige C Johnson et al. Clin Endocrinol (Oxf). 2023 Feb.

Abstract

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, <2.0 for the opposite side and a CLR > 2.3. The specificity was 80%-90% for bilateral disease with AV/IVC cortisol ratio >5.1 bilaterally and a CLR < 1.1.

Conclusions: 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.

Keywords: Cushing syndrome; adrenal glands; adrenal venous sampling; bilateral adrenal masses; cortisol lateralization Ratio; mild autonomous cortisol secretion; subclinical Cushing syndrome.

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