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Master Thesis

Intérêt de la mesure de l’adrénaline dans le cathétérisme des veines surrénaliennes pour le diagnostic de latéralisation de l’hyperaldostéronisme primaire

Abstract : Background: In order to identify the patients carrying a lateralized primary aldosteronism (PA) eligible for unilateral adrenalectomy, adrenal venous sampling (AVS) is currently considered superior to CT scan. The lateralization diagnosis during AVS is based on aldosterone normalization in each adrenal vein to cortisol levels . It is established that some aldosterone producing adenomas (APA) responsible of PA, can also produce cortisol in addition to aldosterone, which might alter the significance of the cortisol-corrected aldosterone ratios during AVS. Objective: We aimed to evaluate the use of epinephrine for aldosterone normalization in AVS, for lateralization diagnosis. Methods: 78 patients with PA had both CT scan and selective AVS in the two adrenal veins, with measurement of aldosterone, cortisol, and epinephrine. Unilateral adrenalectomy was performed in 34 patients, including 28 with lateralization gradient above 4 based on aldosterone/cortisol or aldosterone/epinephrine ratios. 6 patients did not have a positive lateralization gradient, and were operated based on the CT scan results (AVS not lateralized: group A). Histological analysis of some removed adrenal glands and evaluation of postoperative blood pressure outcomes were performed. Results: Among the 28 patients operated based on the AVS gradient, 21 showed the same lateralization gradients with cortisol or epinephrine normalized ratios. (Group B). 5 patients had a positive lateralization gradient based on adrenalin (negative when based on cortisol) (Group C). 2 patients had a positive lateralization gradient based on cortisol only (Group D). The median seize of the patient’s adenomas in group C (20 mm) was larger than that of the group B (10 mm) : p 0.031. Blood pressure outcomes were identical in the 4 groups. Immunohistochemistry of 9 adrenal glands revealed expression of aldosterone-synthesis enzymes (CYP11B2) but also cortisol-synthesis enzymes (CYP17A1 and CYP11B1) on 4 out of 9 studied specimens. Conclusion : We illustrate that in some patients carrying a relatively large APA well distinguished on CT scan, the lateralization gradient normalized to cortisol can be distorted likely due to a tumor cortisol production. This shows that in some cases, AVS normalized to cortisol is inferior to CT scan in lateralization diagnosis of PA, and accentuates the hypothesis that epinephrine can be useful in lateralization gradient scoring and in identifying candidates for surgery.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03406160
Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Wednesday, October 27, 2021 - 4:49:57 PM
Last modification on : Friday, October 29, 2021 - 3:35:13 AM

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Éléa Duparc. Intérêt de la mesure de l’adrénaline dans le cathétérisme des veines surrénaliennes pour le diagnostic de latéralisation de l’hyperaldostéronisme primaire. Médecine humaine et pathologie. 2021. ⟨dumas-03406160⟩

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