Volumetric evaluation of CT images of adrenal glands in primary aldosteronism

OBJECTIVES

To investigate whether adrenal volumetry provides better agreement with adrenal vein sampling (AVS) than conventional CT for subtyping PA. Furthermore, we evaluated whether the size of this contralateral adrenal was a prognostic factor for clinical outcome after unilateral adrenalectomy.

METHODS

We retrospectively analyzed volumes of both adrenal glands of the 180 CT-scans (88/180 with unilateral and 92/180 with bilateral disease) of the patients with PA included in the SPARTACUS trial of which 85 also had undergone an AVS. In addition, we examined CT-scans of 20 healthy individuals to compare adrenal volumes with published normal values.

RESULTS

Adrenal volume was higher for the left than the right adrenal (mean and SD: 6.49 ± 2.77 ml versus 5.25 ± 1.87 ml for the right adrenal; p < 0.001). Concordance between volumetry and AVS in subtyping was 58.8%, versus 51.8% between conventional CT results and AVS (p = NS). The volumes of the contralateral adrenals in the patients with unilateral disease (right 4.78 ± 1.37 ml; left 6.00 ± 2.73 ml) were higher than those of healthy controls reported in the literature (right 3.62 ± 1.23 ml p < 0.001; left 4.84 ± 1.67 ml p = 0.02). In a multivariable analysis the contralateral volume was not associated with biochemical or clinical success, nor with the defined daily doses of antihypertensive agents at 1 year follow-up.

CONCLUSIONS

Volumetry of the adrenal glands is not superior to current assessment of adrenal size by CT for subtyping patients with PA. Furthermore, in patients with unilateral disease the size of the contralateral adrenal is enlarged but its size is not associated with outcome.

Adrenal nodularity and somatic mutations in primary aldosteronism: one node is the culprit?

CONTEXT

Somatic mutations in genes that influence cell entry of calcium have been identified in aldosterone-producing adenomas (APAs) of adrenal cortex in primary aldosteronism (PA). Many adrenal glands removed for suspicion of APA do not contain a single adenoma but nodular hyperplasia.

OBJECTIVE

The objective of the study was to assess multinodularity and phenotypic and genotypic characteristics of adrenals removed because of the suspicion of APAs.

DESIGN AND METHODS

We assessed the adrenals of 53 PA patients for histopathological characteristics and immunohistochemistry for aldosterone (P450C18) and cortisol (P450C11) synthesis and for KCNJ5, ATP1A1, ATP2B3, and CACNA1D mutations in microdissected nodi.

RESULTS

Glands contained a solitary adenoma in 43% and nodular hyperplasia in 53% of cases. Most adrenal glands contained only one nodule positive for P450C18 expression, with all other nodules negative. KCNJ5 mutations were present in 22 of 53 adrenals (13 adenoma and nine multinodular adrenals). An ATP1A1 and a CACNA1D mutation were found in one multinodular gland each and an ATP2B3 mutation in five APA-containing glands. Mutations were always located in the P450C18-positive nodule. In one gland two nodules containing two different KCNJ5 mutations were present. Zona fasciculata-like cells were more typical for KCNJ5 mutation-containing nodules and zona glomerulosa-like cells for the other three genes.

CONCLUSIONS

Somatic mutations in KCNJ5, ATP1A1, or CACNA1D genes are not limited to APAs but are also found in the more frequent multinodular adrenals. In multinodular glands, only one nodule harbors a mutation. This suggests that the occurrence of a mutation and nodule formation are independent processes. The implications for clinical management remain to be determined.

Impaired quality of life in patients in long-term remission of Cushing's syndrome of both adrenal and pituitary origin: a remaining effect of long-standing hypercortisolism?

OBJECTIVE

The determinants that cause impaired quality of life (QOL) in patients in long-term remission of Cushing's syndrome (CS) are unknown. The aim of this study was to get more insight into the patient and disease characteristics related to impaired QOL in these patients.

DESIGN

Cross-sectional study.

METHODS

The QOL of 123 patients in remission of CS (age 52.2 ± 12.0 years, 106 women, duration of remission 13.3 ± 10.4 years, 80% pituitary CS), assessed with seven validated questionnaires, was compared with the QOL of an age- and sex-matched control group (n=105). To investigate the influence of the aetiology of CS on QOL, patients in remission of pituitary and adrenal CS were compared. Furthermore, the influence of hormonal deficiencies, treatment strategy, duration of remission, gender and age on QOL was investigated.

RESULTS

QOL in the total patient group and each patient subgroup was significantly worse on practically all dimensions of questionnaires compared with the control group (P<0.05), except for patients in remission of pituitary CS without hormonal deficiencies who had an impaired QOL on 50% of the QOL dimensions. Subgroup analysis revealed no difference in QOL between different patient groups, especially no difference between patients in remission of adrenal and pituitary CS. Female gender and a shorter duration of remission had a negative influence on QOL in the patient group.

CONCLUSIONS

QOL remains impaired in patients in long-term remission of CS regardless of aetiology, presence of hormonal deficiencies and treatment strategies. More research is needed to establish the causes.

Soil dissipation of diuron, chlorotoluron, simazine, propyzamide, and diflufenican herbicides after repeated applications in fruit tree orchards

In a pear tree orchard planted on loam soil, each plot was treated in April 1998 with either one of the ureas diuron or chlorotoluron, or triazine simazine herbicides applied at 3, 4, and 2 kg AI ha(-1), respectively. Some plots had not been previously treated with one of these herbicides. Other plots had been treated annually during the past 12 years with the same herbicide. One herbicide, and always the same, was thus applied to each plot. In the plots treated for the first time with either diuron, chlorotoluron, or simazine, the soil half-lives of these herbicides in the 0-10 cm surface soil layer were 81, 64, and 59 days, respectively. In the plots treated with the same herbicide for 12 years, the corresponding soil half-lives were 37, 11, and 46 days. Diuron thus produced a moderately enhanced biodegradation, chlorotoluron a high one, and simazine a low but significant one. In another pear tree orchard planted on sandy loam soil, each plot was treated in April 1998 with one of the amide propyzamide (1.25 or 1.0 AI kg ha(-1)) or diflufenican (250 g AI ha(-1)) herbicides. In the plots not previously treated with propyzamide, the propyzamide soil half-life was the same for both doses, i.e., about 30 days. In the plots treated annually for 3 or 14 years with propyzamide, the soil half-life was 12 and 10 days, respectively. In the plots treated for the first time with diflufenican and in those treated annually with diflufenican for 3 years, the diflufenican soil half-life was the same, i.e., 65 days. Propyzamide thus already showed a highly accelerated biodegradation after 3 years of repeated annual applications. Diflufenican, however, did not show enhanced biodegradation after 3 years of repeated annual applications.

Isoxaben soil biodegradation in pear tree orchard after repeated high dose application

During the past nine years, each of the plots of a pear tree orchard were treated annually with the same herbicide treatment. The following herbicide treatments were compared, each being made by application of a mixture of two or three herbicides: 1a, no herbicide at all, weeds being hoed (control 1a); 2, diuron + paraquat 3 + 1 kg/ha; 3, simazine + paraquat 2 + 1 kg/ha; 4, isoxaben + diuron + paraquat 0.5 + 1.6 + 1 kg/ha; and 5, isoxaben + simazine + paraquat 0.5 + 1.25 + 1 kg/ha. In March 1996, one year after the final orchard herbicide treatment, isoxaben could not be detected in the soils of any field plots; isoxaben was incorporated at 0.74 mg/kg in the loamy soils sampled separately in each of the field plots, and the soils were incubated in the laboratory. Isoxaben soil half-lives were 92 days in the soils treated previously with herbicide treatments 1a, 2, or 3 and 42 days in the soils treated with herbicide treatments 4 and 5. The repeated isoxaben treatments applied in the past thus enhanced the isoxaben soil biodegradation; diuron, simazine, and paraquat had no influence on this rate enhancement. On the other hand, herbicide treatments 4 and 5 were applied in the orchard in April 1996 on the corresponding plots treated in this manner for the last nine years. Isoxaben + paraquat 0.5 + 1 kg/ha was applied simultaneously on other plots (control 1b) not treated in the past with isoxaben. During the growth season in the orchard, the isoxaben soil half-lives in the control plots 1b was 101 days, and 41 days in the plots where herbicide treatments 4 or 5 were applied.