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R H Reznek - One of the best experts on this subject based on the ideXlab platform.
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diagnostic performance of ct versus mr in detecting aldosterone producing adenoma in Primary Hyperaldosteronism conn s syndrome
European Radiology, 2004Co-Authors: R K Lingam, S A Sohaib, J P Monson, A B Grossman, G M Besser, Andrea Rockall, Andrea M Isidori, S L Chew, R H ReznekAbstract:The aim of the present study is to compare the diagnostic performance of CT and MR imaging in detecting aldosterone-producing adenoma and to compare the interobserver variability in the detection of an aldosterone-producing adenoma on CT and MR. A retrospective study of 34 patients with Primary Hyperaldosteronism was performed. A total of 17 cases of aldosterone-producing adenoma and 17 cases of bilateral adrenal hyperplasia were included. The final diagnosis of an adenoma was made by surgery with histological confirmation, whereas that of bilateral adrenal hyperplasia was made on adrenal venous sampling or a good biochemical and clinical response following medical treatment alone and in the absence of a unilateral radiological abnormality. The CT (n=30) and MR (n=24) scans were reviewed independently by two radiologists experienced in adrenal imaging, who were unaware of the cause of the Primary Hyperaldosteronism. The diagnostic performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging were compared. The 16 adenomatous nodules that were detected on imaging ranged from 1 to 4.75 cm in diameter. The calculated sensitivity and specificity for detecting aldosterone-producing adenoma were 87 and 93% for one observer and 85 and 82% for the other observer on CT, and 83 and 83% for one observer and 92 and 92% for the other observer on MR, respectively. Receptor operating characteristics curve analysis showed similar performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging. There was good interobserver agreement on CT (k=0.71) and on MR (k=0.67). We have demonstrated comparable diagnostic performance and good interobserver agreement on CT and MR imaging for the detection of aldosterone-producing adenoma.
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ct of Primary Hyperaldosteronism conn s syndrome the value of measuring the adrenal gland
American Journal of Roentgenology, 2003Co-Authors: R K Lingam, S A Sohaib, J P Monson, A B Grossman, I Vlahos, Andrea Rockall, Andrea M Isidori, R H ReznekAbstract:OBJECTIVE. The objectives of our study of patients with Primary Hyperaldosteronism (Conn's syndrome) were to determine whether the adrenal glands are larger in patients with bilateral adrenal hyperplasia than in those with aldosterone-producing adenomas or in healthy control subjects; and whether a CT criterion based on adrenal gland size can be developed to positively diagnose bilateral adrenal hyperplasia.MATERIALS AND METHODS. A retrospective study of CT scans of 28 patients with Primary Hyperaldosteronism was performed. The means of two observers' measurements of adrenal gland size were recorded and compared with published normal values. In addition, a radiologist experienced in adrenal imaging and unaware of the cause of the Primary Hyperaldosteronism diagnosed either bilateral adrenal hyperplasia or aldosterone-producing adenoma by visual inspection.RESULTS. The adrenal glands in patients with bilateral adrenal hyperplasia were significantly (p < 0.05) larger than those in patients with aldosterone-...
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Primary Hyperaldosteronism conn syndrome mr imaging findings
Radiology, 2000Co-Authors: S A Sohaib, P D Peppercorn, C Allan, J P Monson, A B Grossman, G M Besser, R H ReznekAbstract:PURPOSE: To describe the magnetic resonance (MR) imaging features of the adrenal glands in Primary Hyperaldosteronism and assess MR imaging in the detection and characterization of aldosterone-producing adenoma (APA). MATERIALS AND METHODS: The authors retrospectively reviewed the cases of 20 patients (13 female and seven male patients; age range, 14–67 years; median age, 46 years) with Primary Hyperaldosteronism who underwent 1.5-T MR imaging between 1995 and 1998. All patients underwent transverse T1- and T2-weighted imaging, and chemical shift imaging was performed in 17 patients. Imaging results were correlated with findings at biochemical testing, venous sampling, or surgery. RESULTS: Among the 20 patients, 10 (50%) had APA and 10 (50%) bilateral adrenal hyperplasia (BAH). In the detection of APA, MR imaging had a sensitivity of 70%, specificity of 100%, and accuracy of 85%. APAs (mean size, 20 × 16 mm) were iso- or hypointense relative to the liver on T1-weighted images and slightly hyperintense on ...
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relative value of computed tomography scanning and venous sampling in establishing the cause of Primary Hyperaldosteronism
European Journal of Endocrinology, 1996Co-Authors: R Sheaves, G M Besser, R H Reznek, S L Chew, J Goldin, J E Dacie, David G Lowe, Richard Ross, J A H Wass, A B GrossmanAbstract:The purpose of this study was to evaluate the relative merits of the postural stimulation test, adrenal computed tomography (CT) and venous sampling in the differential diagnosis of patients presenting with Primary Hyperaldosteronism. The records of 20 patients presenting with Primary Hyperaldosteronism were reviewed retrospectively. There were 15 patients with a unilateral aldosterone-producing adenoma (APA), four patients with idiopathic Hyperaldosteronism (IHA) and one patient with Primary adrenal hyperplasia (PAH). The postural stimulation test was based on measurements of plasma aldosterone and renin activity at 08.00 h and at noon after 4 h of ambulation. The CT scans of the adrenals were reviewed by a single radiologist. Bilateral venous sampling of adrenal veins was attempted in all patients and blood collected for aldosterone and cortisol assay. Plasma aldosterone concentration increased after 4 h of standing in all cases of hyperplasia but was also demonstrated in 10/15 patients with a surgically-proven APA. If one defines a significant postural rise as being greater than 30%, then 8/15 patients with APA can be considered as being posturally responsive. Computed tomography scanning correctly identified all 15 cases of APA and also classified correctly the remaining five cases of hyperplasia (four cases of IHA and one case of PAH). Venous sampling failed technically in 4/15 cases of APA and in one case of IHA: a total of 5/20 (25%,). A correct diagnosis of APA or IHA was established in all the remaining cases. However, the one case of PAH was treated successfully by adrenalectomy following venous sampling, which suggested a unilateral adrenal lesion: this one result was the only instance where venous sampling altered clinical decision-making. Computed tomography scanning may be used alone to confirm the cause of Hyperaldosteronism where postural studies suggest an adrenal adenoma, and such patients may be considered for early surgery. Venous catheterization studies are not necessary routinely. but may still be useful in selected patients, particularly when CT scanning shows no clear lesion.
Janice L Pasieka - One of the best experts on this subject based on the ideXlab platform.
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modification of the protocol for selective adrenal venous sampling results in both a significant increase in the accuracy and necessity of the procedure in the management of patients with Primary Hyperaldosteronism
Surgery, 2012Co-Authors: Adrian Harvey, Janice L Pasieka, Greg Kline, Benny SoAbstract:Background Adrenal venous sampling (AVS) is used in the work-up of Primary Hyperaldosteronism (PA) to distinguish unilateral PA from bilateral adrenal hyperplasia. In 2006, we reported that only 44% of AVS had biochemical evidence of bilateral adrenal vein cannulation (BAVC). Critical appraisal of our practice resulted in a protocol change. This study examined the impact of this new protocol on both the technical success rate and its influence on management of PA. Methods Since 2006, all patients with biochemically documented PA referred to either a single endocrine surgeon or endocrine specialist underwent AVS. Successful BAVC was defined as an adrenal vein to inferior vena cava/cortisol ratio of >3:1. Lateralization was defined as an aldosterone:cortisol ratio >3 times the unaffected side. Results Of the 86 AVS performed on 84 patients with PA, 82 had BAVC (95%). AVS altered the management in 26 of 84 (31%) patients. Despite clear unilateral findings on imaging in 45 patients, AVS demonstrated bilateral adrenal hyperplasia. in 10 and contralateral disease in 3. AVS confirmed unilateral PA in 5 patients with equivocal Conclusion Our new AVS protocol resulted in a marked improvement in BAVC. AVS influenced management in a third of patients with PA. Surgical decision-making cannot be made solely on the basis of cross-sectional imaging.
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adrenal venous sampling in Primary Hyperaldosteronism comparison of radiographic with biochemical success and the clinical decision making with less than ideal testing
Surgery, 2006Co-Authors: Adria Harvey, Gregory Kline, Janice L PasiekaAbstract:Background Adrenal venous sampling (AVS) is used in the workup of Primary Hyperaldosteronism (PA). The purpose of this study was to determine the success rate of AVS and to examine the decision-making process after “less than ideal” AVS. Methods A total of 60 patients underwent 62 AVS for PA. Biochemical evidence of adrenal vein cannulization was analyzed with adrenal–peripheral cortisol ratios. Pathology and clinical outcomes were reviewed in patients undergoing adrenalectomy. Results Bilateral cannulization was confirmed in only 21% (pre-adrenocorticotropic hormone [ACTH] infusion) and 44% (post-ACTH infusion) AVS. Of 39 patients who underwent adrenalectomy for presumed unilateral disease, only 16 patients had “ideal” AVS, and 18 patients had only unilateral cannulization on AVS. Despite this, 11 appeared to lateralize and 7 had imaging to support unilateral disease. Postoperatively, 15 (82%) had a significant reduction in their blood pressure, and 7 (39%) of these were cured. Surgery failed in 2 patients; both were found to have bilateral hyperplasia. Bilaterally unsuccessful cannulization (n = 5) still lateralized in 3 patients, and 2 patients had nodules on computed tomography scan. All 5 patients had significant reduction in blood pressure, and 2 were cured. Conclusions ACTH infusion during AVS enhances the biochemical evidence of adrenal vein cannulization. Following “less than ideal” AVS, clinical decisions can still be made using anatomic and partial AVS data.
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long term follow up and cost benefit of adrenalectomy in patients with Primary Hyperaldosteronism
British Journal of Surgery, 2002Co-Authors: Mark Sywak, Janice L PasiekaAbstract:Background: The purpose of this study was to evaluate the long-term efficacy of adrenalectomy on blood pressure control in patients with Primary Hyperaldosteronism (HA), and to analyse the cost of adrenalectomy compared with non-surgical management of HA over the patient's lifetime. Methods: All patients who underwent an adrenalectomy for HA were recalled to the endocrine surgical clinic. Data gathered included blood pressure, aldosterone: renin ratios and medication. Total costs for adrenalectomy and ongoing medications were compared with the estimated costs of lifelong medical therapy alone. Results: Twenty-four adrenalectomies were performed for HA, with one death. The mean follow-up was 42 (range 13–97) months. Long term, there was a significant decrease in both the mean diastolic and systolic blood pressure. The aldosterone: renin ratio decreased in 21 patients. Of these patients, 20 were either off all antihypertensives (eight) or had a reduction in medication (12). An increased aldosterone: renin ratio occurred in two patients, both of whom required an increase in antihypertensive medication. Using the predicted life expectancy, the mean estimated cost savings over the lifetime of each patient undergoing adrenalectomy compared with medication alone was Canadian $31 132. Conclusion: Adrenalectomy for HA resulted in significant long-term reduction in blood pressure. Adrenalectomy for HA is a significantly less expensive than long-term medical therapy alone. © 2002 British Journal of Surgery Society Ltd
Barbra S Miller - One of the best experts on this subject based on the ideXlab platform.
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the role of radiologic studies in the evaluation and management of Primary Hyperaldosteronism
Surgery, 2008Co-Authors: Barbra S MillerAbstract:Background Surgical treatment of Primary Hyperaldosteronism (PHA) requires demonstration of unilateral adrenal hypersecretion. Optimal methods for interpretation of imaging and invasive testing are still in development. Methods A retrospective review from 1996–2007 of 106 patients with PHA was undertaken. Patient demographics, biochemical studies, radiologic imaging, operative reports, and pathology were reviewed and comparisons made. Optimal ratios for adrenal vein sampling were tested with regard to sensitivity and specificity. Preoperative and postoperative medication requirements and blood pressures were compared among different treatment groups. Results Seventy-eight patients (62 surgically treated) met criteria for inclusion. Median arterial blood pressure at diagnosis was 150/86 mm Hg while taking 3 antihypertensive medications. 69.2% required potassium supplementation. Median aldosterone:renin ratio was 107.0. Forty-two AVS procedures changed the management of 15 patients (35.7%) when compared to CT results. AVS accuracy was 96.6 vs 88.9% for NP-59 scintigraphy. Operative patients remained on fewer antihypertensive medications (1 vs 3), and mean systolic pressure was lower (130 vs 146 mm Hg) compared with medically managed patients. Conclusion When used together, pre-ACTH aldosterone ratios, normalized A/C:A/C ratios, ratios to define contralateral suppression, and post-ACTH stimulated values allowed for capture of episodically secreting tumors and subtle unilateral or bilateral Hyperaldosteronism.
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the role of radiologic studies in the evaluation and management of Primary Hyperaldosteronism discussion
Surgery, 2008Co-Authors: Matthew L. White, Gerard M Doherty, Gary D. Hammer, Norman W. Thompson, Barbra S Miller, Paul G Gauger, Anders BergenfelzAbstract:Background. Surgical treatment of Primary Hyperaldosteronism (PHA) requires demonstration of unilateral adrenal hypersecretion. Optimal methods for interpretation of imaging and invasive testing are still in development. Methods. A retrospective review from 1996-2007 of 106 patients with PHA was undertaken. Patient demographics, biochemical studies, radiologic imaging, operative reports, and pathology were reviewed and comparisons made. Optimal ratios for adrenal vein sampling were tested with regard to sensitivity and specificity. Preoperative and postoperative medication requirements and blood pressures were compared among different treatment groups. Results. Seventy-eight patients (62 surgically treated) met criteria for inclusion. Median arterial blood pressure at diagnosis was 150/86 mm Hg while taking 3 antihypertensive medications. 69.2% required potassium supplementation. Median aldosterone:renin ratio was 107.0. Forty-two AVS procedures changed the management of 15 patients (35.7%) when compared to CT results. AVS accuracy was 96.6 vs 88.9% for NP-59 scintigraphy. Operative patients remained on fewer antihypertensive medications (1 vs 3), and mean systolic pressure was lower (130 vs 146 mm Hg) compared with medically managed patients. Conclusion. When used together, pre-ACTH aldosterone ratios, normalized A/C:A/C ratios, ratios to define contralateral suppression, and post-ACTH stimulated values allowed for capture of episodically secreting tumors and subtle unilateral or bilateral Hyperaldosteronism.
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Primary Hyperaldosteronism effect of adrenal vein sampling on surgical outcome
Archives of Surgery, 2006Co-Authors: Fiemu E Nwariaku, Barbra S Miller, Richard J Auchus, Shelby A Holt, Lori M Watumull, Bart Dolmatch, Shawna D Nesbitt, Wanpen Vongpatanasin, Ronald G Victor, Frank H WiansAbstract:Hypothesis Adrenal vein sampling is superior to computed tomography for subtype differentiation of Primary Hyperaldosteronism. Design Retrospective review. Setting University medical center. Patients Forty-eight patients (32 men and 16 women) with biochemically confirmed Primary Hyperaldosteronism. Main Outcome Measures We compared demographic factors, results of biochemical and imaging studies (computed tomography and adrenal vein sampling), therapy, and patient outcomes. Results Mean ± SEM adrenal nodule size was 1.54 ± 0.2 cm. Adrenal vein sampling was performed in 41 (85%) of 48 patients, and it was successful in 39 (95%) of those 41 patients. Concordance between computed tomography and adrenal vein sampling was observed in 22 (54%) of the 41 patients. Thirty-two patients underwent successful laparoscopic adrenalectomy. There was 1 complication and no deaths. All 32 patients were cured of hypokalemia. Conclusion Adrenal vein sampling is superior to image-based techniques for subtype differentiation of Primary Hyperaldosteronism.
A B Grossman - One of the best experts on this subject based on the ideXlab platform.
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diagnostic performance of ct versus mr in detecting aldosterone producing adenoma in Primary Hyperaldosteronism conn s syndrome
European Radiology, 2004Co-Authors: R K Lingam, S A Sohaib, J P Monson, A B Grossman, G M Besser, Andrea Rockall, Andrea M Isidori, S L Chew, R H ReznekAbstract:The aim of the present study is to compare the diagnostic performance of CT and MR imaging in detecting aldosterone-producing adenoma and to compare the interobserver variability in the detection of an aldosterone-producing adenoma on CT and MR. A retrospective study of 34 patients with Primary Hyperaldosteronism was performed. A total of 17 cases of aldosterone-producing adenoma and 17 cases of bilateral adrenal hyperplasia were included. The final diagnosis of an adenoma was made by surgery with histological confirmation, whereas that of bilateral adrenal hyperplasia was made on adrenal venous sampling or a good biochemical and clinical response following medical treatment alone and in the absence of a unilateral radiological abnormality. The CT (n=30) and MR (n=24) scans were reviewed independently by two radiologists experienced in adrenal imaging, who were unaware of the cause of the Primary Hyperaldosteronism. The diagnostic performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging were compared. The 16 adenomatous nodules that were detected on imaging ranged from 1 to 4.75 cm in diameter. The calculated sensitivity and specificity for detecting aldosterone-producing adenoma were 87 and 93% for one observer and 85 and 82% for the other observer on CT, and 83 and 83% for one observer and 92 and 92% for the other observer on MR, respectively. Receptor operating characteristics curve analysis showed similar performances of both observers in detecting an aldosterone-producing adenoma on CT and MR imaging. There was good interobserver agreement on CT (k=0.71) and on MR (k=0.67). We have demonstrated comparable diagnostic performance and good interobserver agreement on CT and MR imaging for the detection of aldosterone-producing adenoma.
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ct of Primary Hyperaldosteronism conn s syndrome the value of measuring the adrenal gland
American Journal of Roentgenology, 2003Co-Authors: R K Lingam, S A Sohaib, J P Monson, A B Grossman, I Vlahos, Andrea Rockall, Andrea M Isidori, R H ReznekAbstract:OBJECTIVE. The objectives of our study of patients with Primary Hyperaldosteronism (Conn's syndrome) were to determine whether the adrenal glands are larger in patients with bilateral adrenal hyperplasia than in those with aldosterone-producing adenomas or in healthy control subjects; and whether a CT criterion based on adrenal gland size can be developed to positively diagnose bilateral adrenal hyperplasia.MATERIALS AND METHODS. A retrospective study of CT scans of 28 patients with Primary Hyperaldosteronism was performed. The means of two observers' measurements of adrenal gland size were recorded and compared with published normal values. In addition, a radiologist experienced in adrenal imaging and unaware of the cause of the Primary Hyperaldosteronism diagnosed either bilateral adrenal hyperplasia or aldosterone-producing adenoma by visual inspection.RESULTS. The adrenal glands in patients with bilateral adrenal hyperplasia were significantly (p < 0.05) larger than those in patients with aldosterone-...
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Primary Hyperaldosteronism conn syndrome mr imaging findings
Radiology, 2000Co-Authors: S A Sohaib, P D Peppercorn, C Allan, J P Monson, A B Grossman, G M Besser, R H ReznekAbstract:PURPOSE: To describe the magnetic resonance (MR) imaging features of the adrenal glands in Primary Hyperaldosteronism and assess MR imaging in the detection and characterization of aldosterone-producing adenoma (APA). MATERIALS AND METHODS: The authors retrospectively reviewed the cases of 20 patients (13 female and seven male patients; age range, 14–67 years; median age, 46 years) with Primary Hyperaldosteronism who underwent 1.5-T MR imaging between 1995 and 1998. All patients underwent transverse T1- and T2-weighted imaging, and chemical shift imaging was performed in 17 patients. Imaging results were correlated with findings at biochemical testing, venous sampling, or surgery. RESULTS: Among the 20 patients, 10 (50%) had APA and 10 (50%) bilateral adrenal hyperplasia (BAH). In the detection of APA, MR imaging had a sensitivity of 70%, specificity of 100%, and accuracy of 85%. APAs (mean size, 20 × 16 mm) were iso- or hypointense relative to the liver on T1-weighted images and slightly hyperintense on ...
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relative value of computed tomography scanning and venous sampling in establishing the cause of Primary Hyperaldosteronism
European Journal of Endocrinology, 1996Co-Authors: R Sheaves, G M Besser, R H Reznek, S L Chew, J Goldin, J E Dacie, David G Lowe, Richard Ross, J A H Wass, A B GrossmanAbstract:The purpose of this study was to evaluate the relative merits of the postural stimulation test, adrenal computed tomography (CT) and venous sampling in the differential diagnosis of patients presenting with Primary Hyperaldosteronism. The records of 20 patients presenting with Primary Hyperaldosteronism were reviewed retrospectively. There were 15 patients with a unilateral aldosterone-producing adenoma (APA), four patients with idiopathic Hyperaldosteronism (IHA) and one patient with Primary adrenal hyperplasia (PAH). The postural stimulation test was based on measurements of plasma aldosterone and renin activity at 08.00 h and at noon after 4 h of ambulation. The CT scans of the adrenals were reviewed by a single radiologist. Bilateral venous sampling of adrenal veins was attempted in all patients and blood collected for aldosterone and cortisol assay. Plasma aldosterone concentration increased after 4 h of standing in all cases of hyperplasia but was also demonstrated in 10/15 patients with a surgically-proven APA. If one defines a significant postural rise as being greater than 30%, then 8/15 patients with APA can be considered as being posturally responsive. Computed tomography scanning correctly identified all 15 cases of APA and also classified correctly the remaining five cases of hyperplasia (four cases of IHA and one case of PAH). Venous sampling failed technically in 4/15 cases of APA and in one case of IHA: a total of 5/20 (25%,). A correct diagnosis of APA or IHA was established in all the remaining cases. However, the one case of PAH was treated successfully by adrenalectomy following venous sampling, which suggested a unilateral adrenal lesion: this one result was the only instance where venous sampling altered clinical decision-making. Computed tomography scanning may be used alone to confirm the cause of Hyperaldosteronism where postural studies suggest an adrenal adenoma, and such patients may be considered for early surgery. Venous catheterization studies are not necessary routinely. but may still be useful in selected patients, particularly when CT scanning shows no clear lesion.
Electron Kebebew - One of the best experts on this subject based on the ideXlab platform.
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adrenal vein sampling to distinguish between unilateral and bilateral Primary Hyperaldosteronism to acth stimulate or not
Journal of Clinical Medicine, 2020Co-Authors: Taeyon Sung, Wilson M Alobuia, Monica Tyagi, Chandrayee Ghosh, Electron KebebewAbstract:The aim of this study is to determine the accuracy of adrenal vein sampling (AVS) with and without adrenocorticotropic hormone (ACTH) stimulation to distinguish between unilateral and bilateral Primary Hyperaldosteronism (PA). Retrospective analysis of a prospective database from a referral center between 1984 and 2009, 76 patients had simultaneous cannulation of bilateral adrenal veins and AVS with and without ACTH stimulation. All patients had adrenalectomies. The selectivity index (SI, cut-off value ≥2) was used for confirmation of successful cannulation of the adrenal vein. The lateralization index (LI, cut-off value >2 and >4) was used for distinguishing between unilateral and bilateral PA. The SI ratio was higher with ACTH stimulation compared to without for the right adrenal vein (p = 0.027). The LI >2 ratio was higher with ACTH stimulation compared to without (p = 0.007). For the LI >4 ratio, there was no difference between with and without ACTH stimulation (p = 0.239). However, for a LI >4, 7 patients (9.2%) were not lateralized with ACTH stimulation, but they did lateralize without ACTH stimulation. AVS with ACTH stimulation is associated with a higher SI ratio compared to AVS without ACTH stimulation. However, when using LI >4 for AVS, samples without ACTH stimulation should also be included to detect a subset of patients with unilateral disease that are not detected with ACTH stimulation.
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adrenal histologic findings show no difference in clinical presentation and outcome in Primary Hyperaldosteronism
Annals of Surgical Oncology, 2013Co-Authors: Allison B Weisbrod, Aarti Mathur, Constantine A Stratakis, Richard C Webb, Stephanie Barak, Smita Baid Abraham, Naris Nilubol, Martha Quezado, Electron KebebewAbstract:Background Primary Hyperaldosteronism is most commonly due to a solitary cortical adenoma. Thus, some surgeons have suggested a subtotal adrenalectomy is a reasonable approach when a mass can be identified. On the other hand, adrenal vein sampling (AVS) is being used more frequently to distinguish patients with unilateral disease for adrenalectomy, even if a discrete mass is not identified on axial imaging. In these cases, surgical pathology may reveal a cortical adenoma, a cortical adenoma with hyperplasia, or cortical hyperplasia. The goal of this study was to compare the presentation and outcome among patients undergoing adrenalectomy and found to have different histologic features.
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what is the best criterion for the interpretation of adrenal vein sample results in patients with Primary Hyperaldosteronism
Annals of Surgical Oncology, 2012Co-Authors: Richard C Webb, Aarti Mathur, Constantine A Stratakis, Smita Baid, Steven K Libutti, Naris Nilubol, Richard L Chang, Electron KebebewAbstract:Background In patients with Primary Hyperaldosteronism, adrenal vein sampling (AVS) has emerged as a gold standard for distinguishing between unilateral and bilateral disease, but multiple criteria have been used and no consensus exists as to the most accurate criterion. The objective of this study was to determine which AVS criteria most accurately identify patients with unilateral surgical disease and are associated with significant clinical improvement after adrenalectomy.