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Zhou Q, Liu X, Zhang H, Zhao Z, Li Q, He H, Zhu Z, Yan Z. Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy. Diabetes Metab Syndr Obes 2020; 13:3519-3525. [PMID: 33116703 PMCID: PMC7547795 DOI: 10.2147/dmso.s262092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/18/2020] [Indexed: 12/22/2022] Open
Abstract
AIM Hypercortisolism is characterized by metabolic disorders and high mortality rates. Adrenalectomy and medical therapies are considered major treatment options. However, some patients, especially young patients, are strongly against undergoing surgery in case of secondary hypocortisolism or relapses that require replacement supplements or pharmacological interventions. In such cases, alternative therapies are needed to treat hypercortisolism. METHODS We report a 27-year-old Chinese female with adrenal cortisol-producing adenoma. The patient's circadian rhythm and concentrations of cortisol were abnormal, accompanying with an increased 24-hour urinary cortisol level. Computed tomography (CT) revealed a nodular soft-tissue mass in the right adrenal gland. RESULTS Cortisol hypersecretion from the right adrenal gland was verified by adrenal venous sampling (AVS). Adrenal artery ablation was performed. After ablation, long-term follow-up showed that the patient's symptoms subsided and abnormal laboratory test results returned to normal without pharmacological treatment. CONCLUSION AVS might be a promising method to aid the diagnosis of cortisol-producing adenoma. Adrenal artery ablation is minimally invasive and may be useful for the treatment of adrenal adenoma or nodular diseases, especially in patients who cannot undergo surgery.
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Affiliation(s)
- Qing Zhou
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
| | - Xiaoli Liu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
| | - Hexuan Zhang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
| | - Zhigang Zhao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
| | - Qiang Li
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
| | - Hongbo He
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
| | - Zhencheng Yan
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of China
- Correspondence: Zhencheng Yan Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Daping Hospital and the Research Institute of Surgery, Army Medical University, Chongqing400042, People’s Republic of ChinaTel +86-23-68757883 Email
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Varlamov E, Hinojosa-Amaya JM, Stack M, Fleseriu M. Diagnostic utility of Gallium-68-somatostatin receptor PET/CT in ectopic ACTH-secreting tumors: a systematic literature review and single-center clinical experience. Pituitary 2019; 22:445-455. [PMID: 31236798 DOI: 10.1007/s11102-019-00972-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Tumors causing ectopic Cushing's syndrome (ECS) are often not visible with conventional imaging. Gallium-68-DOTATATE, DOTATOC, and DOTANOC positron emission tomography/computed tomography (68Ga-SSTR PET/CT) reportedly exhibits greater sensitivity in identifying an ECS source, however, evidence is limited to mainly case reports and a few small retrospective studies. Previous systematic ECS imaging review has shown 68Ga-SSTR PET/CT sensitivity is similar to CT (81.8%) in histologically-proven cases and is 100% in covert-cases, however, the number of patients was small and no occult cases were reported. METHODS We performed a systematic literature review of 68Ga-SSTR PET/CT use in ECS patients. We also report 6 consecutive patients with confirmed active and occult ECS who underwent 68Ga-DOTATATE PET/CT and were followed at our institution between 2014 and 2019. RESULTS We identified 33 articles (23 case-reports, 4 case-series, 5 retrospective studies and 1 prospective study) detailing 68Ga-SSTR PET/CT in 69 ECS patients. Overall 68Ga-SSTR PET/CT sensitivity was 64.0%, while in histologically confirmed cases (67 lesions), sensitivity was 76.1%. There were two false-positives cases, both in the adrenal glands. In covert cases, 68Ga-SSTR PET/CT identified 50% of lesions. There were ten occult cases where all imaging failed to identify an adrenocorticotropic hormone source; source remains unknown. In our case series, 68Ga-DOTATATE PET/CT showed decreased uptake in pancreatic neuroendocrine tumor in one patient and did not help identify an ECS source in 5 patients. CONCLUSION Both this systematic literature review, the largest to date, and our single- center experience demonstrate a lower than previously reported 68Ga-SSTR PET/CT sensitivity for ECS, especially in occult lesions. We suggest that the data on 68Ga-SSTR PET/CT in ECS is subject to publication bias, and false-negatives are likely underreported; it's diagnostic value for ECS needs further study.
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Affiliation(s)
- Elena Varlamov
- Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, L607, Portland, OR, USA
- Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Ave, Mail Code CH8N, Portland, OR, USA
- Northwest Pituitary Center, Oregon Health & Science University, 3303 SW Bond Ave, Mail Code CH8N, Portland, OR, USA
| | - José Miguel Hinojosa-Amaya
- Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Ave, Mail Code CH8N, Portland, OR, USA
- Northwest Pituitary Center, Oregon Health & Science University, 3303 SW Bond Ave, Mail Code CH8N, Portland, OR, USA
- Endocrinology Division, Department of Medicine, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Madeleine Stack
- Northwest Pituitary Center, Oregon Health & Science University, 3303 SW Bond Ave, Mail Code CH8N, Portland, OR, USA
| | - Maria Fleseriu
- Department of Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, L607, Portland, OR, USA.
- Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Ave, Mail Code CH8N, Portland, OR, USA.
- Northwest Pituitary Center, Oregon Health & Science University, 3303 SW Bond Ave, Mail Code CH8N, Portland, OR, USA.
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Chan C, Roberts JM. Ectopic ACTH syndrome complicated by multiple opportunistic infections treated with percutaneous ablation of the adrenal glands. BMJ Case Rep 2017; 2017:bcr-2017-221580. [PMID: 29141926 PMCID: PMC5695357 DOI: 10.1136/bcr-2017-221580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 12/28/2022] Open
Abstract
Ectopic adrenocorticotropic hormone (ACTH)-related Cushing's syndrome can lead to multiple complications including severe immunosuppression. If the ACTH-secreting tumour cannot be found, definitive treatment is surgical adrenalectomy, typically followed by glucocorticoid replacement. Here, we present a case of fulminant respiratory failure secondary to coinfection with Pneumocystis jirovecii and cytomegalovirus in a patient with ectopic ACTH-dependent Cushing's syndrome with occult primary. Due to significant deconditioning, she was unable to undergo definitive adrenalectomy and instead underwent percutaneous microwave ablation of the adrenal glands.
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Affiliation(s)
- Chrystal Chan
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - James Mark Roberts
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Kim KJ, Yu JH, Kim NH, Kim YH, Kim YS, Seo JA. A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome. Front Endocrinol (Lausanne) 2017; 8:123. [PMID: 28642733 PMCID: PMC5462915 DOI: 10.3389/fendo.2017.00123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Laboratory results revealed ACTH-dependent Cushing syndrome, but imaging studies did not show any discrete lesions secreting ACTH. The petrosal to peripheral ACTH gradient resulted in no evidence of pituitary adenoma. As the only lesion suspicious for ectopic ACTH secretion was a right lower round cystic lesion that did not appear to be a carcinoid tumor on computed tomography scan of the chest, the patient underwent video-assisted thoracic surgical resection to provide a definitive diagnosis. The final diagnosis was a small ectopic ACTH-secreting carcinoid tumor with unusual superimposed aspergilloma in the periphery of the lung. Postoperatively, the abnormal endocrine levels were normalized, and all of the clinical symptoms and signs were ameliorated. This is an informative case of ectopic ACTH syndrome (EAS) that was the cause of hypokalemia, hypertension, metabolic alkalosis, and hypercortisolism despite its poorly specific cushingoid morphology and uncommon imaging findings. Therefore, we recommend that clinicians investigate any possible lesion as a potential source of EAS.
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Affiliation(s)
- Kyoung Jin Kim
- Division of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Ji Hee Yu
- Division of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Nan Hee Kim
- Division of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Young Hye Kim
- Department of Pathology, Gil Medical Center, Gachon University, Incheon, South Korea
| | - Young Sik Kim
- Department of Pathology, Korea University College of Medicine, Seoul, South Korea
| | - Ji A Seo
- Division of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
- *Correspondence: Ji A Seo,
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