Adrenal gland
Ru Zhang 1 , German Rubinstein 1 , Sharmilee Vetrivel 1 , Frederick Vogel 1 , Matthias Kroiss 1,2 , Sinan Deniz 3 , Andrea Osswald 1 , Thomas Knösel 4 , Sonja Kunz 1 , Martin Bidlingmaier 1 , Silviu Sbiera 2 , Martin Reincke 1 & Anna Riester 1*
1LMU Klinikum; [email protected]; 1Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-University, Munich, Germany; 2Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany; 3Klinik und Poliklinik für Radiologie, Ludwig-Maximilians-University, Munich, Germany; 4Pathologisches Institut, Ludwig-Maximilians-University, Munich, Germany
Background: Primary bilateral macronodular adrenocortical hyperplasia (PBMAH) is a rare cause of ACTH-independent Cushing’s syndrome. The clinical application of adrenal venous sampling (AVS) in diagnostic work-up for PBMAH is still controversially discussed. AVS might be useful in evaluating the predominant side and guiding the decision for unilateral adrenalectomy in PBMAH.
Objectives: Our aim was to evaluate whether certain metabolites in AVS samples could help in successful identification of the dominant side and to characterize possible biochemical differences between the adrenals in PBMAH patients.
Methods: For this retrospective analysis, we included 17 patients with PBMAH of the German Cushing’s registry who underwent AVS without ACTH stimulation. Using LC-MS/MS we quantified 15 steroids, of which 11 adrenal specific steroids were included in the analysis. All data were evaluated by SPSS 26.0 and Graphpad prism 8.0.
Results: Cortisol and DHEAS was the most dominant metabolites in AVS samples. Correlation matrix analysis showed that DHEAS had no significant correlation with any other steroids and was most stable across the samples. Based on this finding, DHEAS was taken as the reference. Using DHEAS based lateralization index (cut off 2.0) adrenals were divided into dominant and non-dominant adrenals. Conversion ratios (metabolite/its precursor) (Zhai et al. 2015) identified unique differences between the adrenals. Particularly, the conversion ratio of aldosterone from its precursor Corticosterone, mediated by CYP11B2 is higher in non-dominant than in dominant adrenals (aldosterone/corticosterone, P<0.05).
Conclusions: This study characterize the biochemical output of adrenals in AVS samples of patients with PBMAH. The analysis helps to identify key steps in the metabolite pathway, that appear dysregulated especially in dominant adrenal gland. Furthermore, the study also characterize DHEAS as a potential reference hormone in future AVS measurements.
Volume 75
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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