Corticotropin-releasing hormone test predicts the outcome of unilateral adrenalectomy in primary bilateral macronodular adrenal hyperplasia.

Autor: Tizianel I; Endocrine Unit, Department of Medicine DIMED, Padua, Italy.; Endocrine Unit, University-Hospital of Padova, Padua, Italy., Detomas M; University Hospital, University of Würzburg, Würzburg, Germany, Department of Internal Medicine I, Division of Endocrinology and Diabetes, Würzburg, Germany., Deutschbein T; University Hospital, University of Würzburg, Würzburg, Germany, Department of Internal Medicine I, Division of Endocrinology and Diabetes, Würzburg, Germany.; Medicover Oldenburg MVZ, Oldenburg, Germany., Fassnacht M; University Hospital, University of Würzburg, Würzburg, Germany, Department of Internal Medicine I, Division of Endocrinology and Diabetes, Würzburg, Germany., Albiger N; Radiotherapy Unit, Istituto Oncologico Veneto, Endocrinology, ULSS6, Padua, Euganea, Italy., Iacobone M; Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy., Scaroni C; Endocrine Unit, Department of Medicine DIMED, Padua, Italy.; Endocrine Unit, University-Hospital of Padova, Padua, Italy., Ceccato F; Endocrine Unit, Department of Medicine DIMED, Padua, Italy. filippo.ceccato@unipd.it.; Endocrine Unit, University-Hospital of Padova, Padua, Italy. filippo.ceccato@unipd.it.
Jazyk: angličtina
Zdroj: Journal of endocrinological investigation [J Endocrinol Invest] 2024 Mar; Vol. 47 (3), pp. 749-756. Date of Electronic Publication: 2023 Oct 05.
DOI: 10.1007/s40618-023-02204-2
Abstrakt: Purpose: Primary bilateral adrenal hyperplasia (PBMAH) is associated with hypercortisolism and a heterogeneous clinical expression in terms of cortisol secretion and related comorbidities. Historically, treatment of choice was bilateral adrenalectomy (B-Adx); however, recent data suggest that unilateral adrenalectomy (U-Adx) may be an effective alternative. For the latter, factors predicting the postsurgical outcome (e.g., biochemical control) have not been identified yet.
Methods: PBMAH patients undergoing U-Adx for overt Cushing's syndrome (CS) in two tertiary care centers were retrospectively analysed. Remission was defined as a normalization of urinary free cortisol (UFC) without the need for medical treatment. The potential of hCRH test as a predictor of U-Adx outcome was evaluated in a subgroup.
Results: 23 patients were evaluated (69% females, mean age 55 years). Remission rate after U-Adx was 74% at last follow up (median 115 months from UAdx). Before U-Adx, a positive ACTH response to hCRH (Δ%ACTH increase > 50% from baseline) was associated with higher remission rates.
Conclusions: Three of four patients with PBMAH are surgically cured with U-Adx. Pre-operative hCRH testing can be useful to predict long-term remission rates.
(© 2023. The Author(s).)
Databáze: MEDLINE
Externí odkaz: