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Roseland ME, Zhang M, Caoili EM. Imaging of pregnant and lactating patients with suspected adrenal disorders. Rev Endocr Metab Disord 2023; 24:97-106. [PMID: 35624403 DOI: 10.1007/s11154-022-09733-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 02/01/2023]
Abstract
A high level of clinical suspicion is essential in the diagnosis and management of a suspected adrenal mass during pregnancy and the peripartum period. Timely recognition is important in order to improve fetal and maternal outcomes. Imaging is often performed to confirm a suspected adrenal lesion; however, increasing usage of diagnostic imaging during pregnancy and lactation has also increased awareness, concerns and confusion regarding the safety risks regarding fetal and maternal exposure to radiation and imaging intravenous contrast agents. This may lead to anxiety and avoidance of imaging examinations which can delay diagnosis and appropriate treatment. This article briefly reviews evidence-based recommended imaging modalities during pregnancy and the lactation period for the assessment of a suspected adrenal mass while recognizing that no examination should be withheld when the exam is necessary to confirm an important clinical suspicion. The imaging characteristics of the more common adrenal pathologies that may affect pregnant women are also discussed.
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Affiliation(s)
- Molly E Roseland
- Department of Radiology, Michigan Medicine, 1500. E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Man Zhang
- Department of Radiology, Michigan Medicine, 1500. E. Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Elaine M Caoili
- Department of Radiology, Michigan Medicine, 1500. E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Lopez AG, Duparc C, Renouf S, Machevin E, Le Guillou V, Sabourin JC, Defortescu G, Buffet A, Gimenez-Roqueplo AP, Dubessy C, Louiset E, Lefebvre H. Expression of LHCGR (Luteinizing Hormone/Chorionic Gonadotrophin Receptor) in Pheochromocytomas Unveils an Endocrine Mechanism Connecting Pregnancy and Epinephrine Overproduction. Hypertension 2022; 79:1006-1016. [PMID: 35189708 DOI: 10.1161/hypertensionaha.121.18864] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mechanisms by which pregnancy may unmask pheochromocytomas and paragangliomas are not totally understood. We hypothesized that gestational hormones may participate in the pathophysiology of catecholamine excess during pregnancy. We report a case of silent pheochromocytoma revealed in a pregnant woman by life-threatening adrenergic myocarditis. METHODS In vitro studies were conducted to investigate the effect of estradiol and the pregnancy hormone hCG (human chorionic gonadotropin) on epinephrine secretion by cultured cells derived from the patient's tumor. Expression of LHCG (luteinizing hormone/chorionic gonadotropin) receptor was searched for in the patient's tumor, and a series of 12 additional pheochromocytoma by RT-Q-PCR and immunohistochemistry. LHCGR expression was also analyzed in silico in the pheochromocytomas and paragangliomas cohorts of the Cortico et Médullosurrénale: les Tumeurs Endocrines and The Cancer Genome Atlas databases. RESULTS hCG stimulated epinephrine secretion by cultured cells derived from the patient's pheochromocytoma. The patient's tumor expressed the LHCG receptor, which was colocalized with catecholamine-producing enzymes. A similar expression pattern of the LHCG receptor was also observed in 5 out of our series of pheochromocytoma. Moreover, in silico studies revealed that pheochromocytomas and paragangliomas display the highest expression levels of LHCG receptor mRNA among the 32 solid tumor types of The Cancer Genome Atlas cohort. CONCLUSIONS Pregnancy may thus favor surges in plasma catecholamine and hypertensive crises through hCG-induced stimulation of epinephrine production by pheochromocytomas.
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Affiliation(s)
- Antoine-Guy Lopez
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.).,Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, France. (A.-G.L., H.L.)
| | - Céline Duparc
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.)
| | - Sylvie Renouf
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.)
| | - Elise Machevin
- Department of Gynaecology-Obstetrics, Evreux Hospital Centre, France (E.M.)
| | - Vincent Le Guillou
- Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, France. (V.L.G.)
| | - Jean-Christophe Sabourin
- Department of Pathology and INSERM 1245, Rouen University Hospital, France. (J.-C.S,).,Tumor BioBank-Centre for Biological Resources, Rouen University Hospital, France. (J.-C.S., H.L.)
| | - Guillaume Defortescu
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.).,Department of Urology, Rouen University Hospital, France. (G.D.)
| | - Alexandre Buffet
- Université de Paris, PARCC, INSERM, Paris, France (A.B., A.-P.G.-R.).,Service de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges Pompidou, Paris, France (A.B., A.-P.G.-R.)
| | - Anne-Paule Gimenez-Roqueplo
- Université de Paris, PARCC, INSERM, Paris, France (A.B., A.-P.G.-R.).,Service de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital européen Georges Pompidou, Paris, France (A.B., A.-P.G.-R.)
| | - Christophe Dubessy
- Normandie University, UNIROUEN, INSERM, PRIMACEN, Rouen, France (C. Dubessy)
| | - Estelle Louiset
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.)
| | - Hervé Lefebvre
- Normandie University, UNIROUEN, INSERM U1239, NorDIC, Rouen, France (A.-G.L., C. Duparc, S.R., C. Dubessy, E.L., H.L.).,Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, France. (A.-G.L., H.L.).,Tumor BioBank-Centre for Biological Resources, Rouen University Hospital, France. (J.-C.S., H.L.)
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