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  • 1
    Online Resource
    Online Resource
    Adrenal Venous Sampling–Guided Adrenalectomy Rates in Primary Aldosteronism: Results of an International Cohort (AVSTAT)
    The Endocrine Society ; 2021
    In:  The Journal of Clinical Endocrinology & Metabolism Vol. 106, No. 3 ( 2021-03-08), p. e1400-e1407
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 106, No. 3 ( 2021-03-08), p. e1400-e1407
    Abstract: Adrenal venous sampling (AVS) is the current criterion standard lateralization technique in primary aldosteronism (PA). Japanese registry data found that 30% of patients with unilateral PA did not undergo adrenalectomy, but the reasons for this and whether the same pattern is seen internationally are unknown. Objective To assess the rate of AVS-guided adrenalectomy across an international cohort and identify factors that resulted in adrenalectomy not being performed in otherwise eligible patients. Design, Setting, and Participants Retrospective, multinational, multicenter questionnaire-based survey of management of PA patients from 16 centers between 2006 and 2018. Main Outcome Measures Rates of AVS implementation, AVS success rate, diagnosis of unilateral PA, adrenalectomy rate, and reasons why adrenalectomy was not undertaken in patients with unilateral PA. Results Rates of AVS implementation, successful AVS, and unilateral disease were 66.3%, 89.3% and 36.9% respectively in 4818 patients with PA. Unilateral PA and adrenalectomy rate in unilateral PA were lower in Japanese than in European centers (24.0% vs 47.6% and 78.2% vs 91.4% respectively). The clinical reasoning for not performing adrenalectomy in unilateral PA were more likely to be physician-derived in Japan and patient-derived in Europe. Physician-derived factors included non-AVS factors, such as good blood pressure control, normokalemia, and the absence of adrenal lesions on imaging, which were present before AVS. Conclusion Considering the various unfavorable aspects of AVS, stricter implementation and consideration of surgical candidacy prior to AVS will increase its diagnostic efficiency and utility.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/clinem/dgaa706
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2021
    detail.hit.zdb_id: 2026217-6
    detail.hit.zdb_id: 3029-6
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  • 2
    Online Resource
    Online Resource
    Hyperthyroidism in patients with ischaemic heart disease after iodine load induced by coronary angiography: Long‐term follow‐up and influence of baseline thyroid functional status
    Wiley ; 2018
    In:  Clinical Endocrinology Vol. 88, No. 2 ( 2018-02), p. 272-278
    Details
    In: Clinical Endocrinology, Wiley, Vol. 88, No. 2 ( 2018-02), p. 272-278
    Abstract: To study the effect of a iodine load on thyroid function of patients with ischaemic heart disease ( IHD ) and the long‐term influence of unknown subclinical hyperthyroidism. Context Subclinical hyperthyroidism is considered an independent risk factors for cardiovascular morbidity of patients with IHD . They routinely undergo coronary angiography with iodine contrast media ( ICM ) which may induce or even worsen hyperthyroidism. Design A cross‐sectional study followed by a longitudinal study on patients with subclinical hyperthyroidism. Patients 810 consecutive IHD outpatients without known thyroid diseases or treatment with drugs influencing thyroid activity undergoing elective coronary angiography. Measurements We evaluated thyroid function either before and 1 month after ICM ; patients with thyrotoxicosis at baseline or after ICM were then followed up for 1 year. Results 58 patients had hyperthyroidism at baseline ( HB , 7.2%), independently associated to FT 4 levels, thyroid nodules and family history of thyroid diseases. After ICM , the prevalence of hyperthyroidism was 81 (10%). Hyperthyroidism after ICM was positively predicted by baseline fT 4 levels, thyroid nodules, age over 60, male gender, family history of thyroid diseases. Three months after ICM , 34 patients (4.2%) still showed hyperthyroidism (22 from HB , 13 treated with methimazole). One year after ICM , hyperthyroidism was still present in 20 patients (2.5%, all from HB , 13 treated). Conclusions The prevalence of spontaneous subclinical hyperthyroidism in IHD is surprisingly elevated and is further increased by iodine load, particularly in patients with thyroid nodules and familial history of thyroid diseases, persisting in a not negligible number of them even after one year.
    Type of Medium: Online Resource
    ISSN: 0300-0664 , 1365-2265
    URL: Issue
    URL: Article
    DOI: 10.1111/cen.2018.88.issue-2
    DOI: 10.1111/cen.13494
    RVK:
    XA 10000
    Language: English
    Publisher: Wiley
    Publication Date: 2018
    detail.hit.zdb_id: 121745-8
    detail.hit.zdb_id: 2004597-9
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  • 3
    Online Resource
    Online Resource
    Assessing Lateralization Index of Adrenal Venous Sampling for Surgical Indication in Primary Aldosteronism
    The Endocrine Society ; 2024
    In:  The Journal of Clinical Endocrinology & Metabolism ( 2024-05-15)
    Details
    In: The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, ( 2024-05-15)
    Abstract: Clinical practice guidelines recommend the lateralization index (LI) as the standard for determining surgical eligibility in primary aldosteronism (PA). Objective Our goal was to identify the optimal LI cutoffs in adrenal venous sampling (AVS) for diagnosing PA that is amenable to surgical cure. Methods We conducted a retrospective international cohort study across 16 institutions in 11 countries, including 1550 patients with PA who underwent AVS, with and/or without adrenocorticotropin (ACTH) stimulation. The establishment of optimal cutoffs was informed by a survey of 82 patients with PA in Japan, aimed at determining the LI cutoff aligned with patient expectations for a surgical cure rate. Results The survey revealed that a median cure rate expectation of 80% would motivate patients with PA towards undergoing adrenalectomy. The optimal LI cutoffs achieving an adjusted positive predictive value (PPV) of 80% were identified as 3.8 for unstimulated AVS and 3.4 for ACTH-stimulated AVS. Furthermore, a contralateral ratio of less than 0.4 and the detection of an adrenal nodule on computed tomography imaging were identified as independent predictors of surgically curable PA. Incorporating these factors with the optimal LI cutoffs, the adjusted PPV increased to 96.6% for unstimulated AVS and 89.6% for ACTH-stimulated AVS. No clear differences in predictive ability between unstimulated and ACTH-stimulated LI were found. Conclusion The present study clarified the optimal LI cutoffs for without and with ACTH stimulation. The presence of contralateral suppression and adrenal nodule on CT imaging seems to provide additional available information besides LI for surgical indication.
    Type of Medium: Online Resource
    ISSN: 0021-972X , 1945-7197
    URL: Article
    DOI: 10.1210/clinem/dgae336
    RVK:
    XA 10000
    Language: English
    Publisher: The Endocrine Society
    Publication Date: 2024
    detail.hit.zdb_id: 2026217-6
    detail.hit.zdb_id: 3029-6
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  • 4
    Online Resource
    Online Resource
    Minimally invasive adrenalectomy for large pheochromocytoma: not recommendable yet? Results from a single institution case series
    Springer Science and Business Media LLC ; 2022
    In:  Langenbeck's Archives of Surgery Vol. 407, No. 1 ( 2022-02), p. 277-283
    Details
    In: Langenbeck's Archives of Surgery, Springer Science and Business Media LLC, Vol. 407, No. 1 ( 2022-02), p. 277-283
    Abstract: Minimally invasive adrenalectomy represents the treatment of choice of pheochromocytoma (PCC). For large or invasive PCCs, an open approach is currently recommended, in order to ensure complete tumor resection, prevent tumor rupture, avoid local recurrence, and limit perioperative hemodynamic instability. The aim of this study is to analyze perioperative outcomes of laparoscopic adrenalectomies (LAs) for large adrenal PCCs. Methods All consecutive LAs for PCC performed at a single institution between 1998 and 2020 were included. Two groups were defined: lesions larger (group 1) and smaller (group 2) than 5 cm. Short-term outcomes were compared in order to find any significant difference between the two groups. Outcomes One hundred fourteen patients underwent LA during the study period: 46 for lesions larger and 68 for lesions smaller than 5 cm. No significant differences were found in patients’ characteristics, median operative time, conversion rate, intraoperative hemodynamic and metabolic parameters, postoperative intensive care unit (ICU) admission rate, complications rate, and length of hospital stay. Long-term oncologic outcomes were similar, with a recurrence rate of 5.1% in group 1 vs 3.6% in group 2 ( p  = 1). Conclusion Minimally invasive adrenalectomy seems to be safe and effective even in large PCC. The recommendation to prefer an open approach for large PCCs should probably be reconsidered.
    Type of Medium: Online Resource
    ISSN: 1435-2443 , 1435-2451
    URL: Article
    DOI: 10.1007/s00423-021-02312-8
    RVK:
    XA 26500
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1459390-7
    detail.hit.zdb_id: 1423681-3
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