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

• DOI: 10.1007/s12020-022-03020-z
• Publication Date: 2022-03-10T19:02:37Z
• Authors: German Rubinstein; Andrea Osswald; Leah Theresa Braun; Frederick Vogel; Matthias Kroiss; Stefan Pilz; Sinan Deniz; Laura Aigner; Thomas Knösel; Jérôme Bertherat; Lucas Bouys; Roland Ladurner; Anna Riester; Martin Bidlingmaier; Felix Beuschlein; Martin Reincke
• Keywords: Adrenocortical adenoma

Primary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a rare cause of ACTH-independent Cushing's syndrome. Current guidelines recommend adrenalectomy for PBMAH, but several studies showed clinical effectiveness unilateral despite disease in selected patients. Our aim was to evaluate the gain information which can be obtained through adrenal venous sampling (AVS) based cortisol lateralization ratios guidance adrenalectomy.We performed retrospective analysis 16 patients with PBMAH and overt secretion three centers METHODS: Selectivity vein during AVS defined as gradient or reference hormone ≥2.0 between peripheral vein. Lateralization assumed if dominant non-dominant ratio ≥4.0.AVS technically successful all on absolute levels 13 (81%) levels. documented 8 In lateralization, 5 cases this occurred toward morphologically larger adrenals, while 3 present bilaterally identical adrenals. The combined volume adrenals correlated positively urinary free cortisol, suggesting that size determinant secretion.In study limited marked asymmetry.