A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

AbstractCraniopharyngiomas are rare solid or mixed solid and cystic tumors that arise from Rathke’s pouch remnants along the pituitary-hypothalamic axis, from the sella turcica to the brain third ventricle. Both the tumor and its treatment can lead to significant neurological and endocrinological complications. Due to the essential role of the hypothalamus in the complex neurophysiologic process of sleep, tumors involving the hypothalamic area may be responsible for disturbances in sleep–wake regulation with alterations in the circadian rhythm, sleep fragmentation, and increased daytime sleepiness. We report two cases of patients with craniopharyngioma, who came to our attention due to the occurrence of episodes characterized by psychomotor slowing and afinalistic limb movements, temporal and spatial disorientation, psychomotor agitation, and oneiric stupor like episodes. A comprehensive clinical data collection and a targeted diagnostic work-up led to a diagnosis of severe sleep disorder characterized by hypersomnia, altered sleep–wake rhythm, and sleep-related breathing disorder. In addition, the polysomnography revealed peculiar alterations in the sleep structure. The diagnostic work-up lead to an accurate differential diagnosis between epileptic seizures and episodes expressions of sleep disturbances. These clinical features can be challenging to diagnose and can lead to misdiagnosis and inappropriate treatment. Diagnosis of sleep disorders is crucial, considering the impact of sleep on general health, cognition, and neuropsychological functioning. These findings support the need to incorporate a comprehensive sleep evaluation in childhood brain tumor involving the suprasellar/hypothalamic region.

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Risk of depression following prostate cancer work-up: A nationwide study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.5061 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 5061-5061

Author(s):

Anne Sofie Friberg ◽

Klaus Brasso ◽

Elisabeth Wreford Andersen ◽

Signe Benzon Larsen ◽

John Thomas Helgstrand ◽

...

Keyword(s):

Prostate Cancer ◽

Cumulative Incidence ◽

Treatment Modalities ◽

Income Quintile ◽

Increased Risk ◽

Diagnostic Work ◽

The Impact ◽

Work Up ◽

Diagnostic Work Up

5061 Background: Little is known about the psychological impact of undergoing evaluation for prostate cancer (PCa). We investigated the risk of developing a depression following PCa work-up with benign and malignant findings, respectively, compared with cancer-free men. Methods: A nationwide cohort of men who underwent prostate needle biopsies in Denmark from 1997–2011 was identified through the Danish Prostate Cancer Registry. Primary outcome was indication of moderate to severe depression defined as hospital contact for depression or first redemption of a prescribed antidepressant. For comparison, we selected a minimum of five age-matched cancer-free men per man who had undergone PCa specific diagnostic work-up. We excluded men with other cancer, major psychiatric disorder or use of antidepressants up to three years before study entry. Information on outcome and covariates (age, period, cohabitation status, income quintile and comorbidity) were retrieved from National Danish registries. We illustrated the risk of depression by cumulative incidence functions. Data were analyzed using Cox models adjusted for possible confounders. Results: We identified 54,766 men who underwent work-up including transrectal biopsies of the prostate, among these, 21,419 biopsy sets were benign and 33,347 men were diagnosed with PCa. We found an increasing cumulative incidence of depression in all groups. However, men diagnosed with PCa had a significantly higher risk throughout up to 18 years of follow-up. The adjusted hazard ratio (HR) of depression in men diagnosed with PCa was increased throughout follow-up with the highest risk in the two years following diagnosis (HR 2.77, 95% CI 2.66–2.87). After undergoing biopsies, men with benign results had an increased risk of depression (HR 1.22, 95% CI 1.14–1.31) in the first two years compared with cancer-free men; hereafter, we found no difference. Conclusions: We found an increased risk of depression in men following diagnostic work-up for PCa compared with a matched background population. In men diagnosed with PCa, the risk remained increased throughout the study period. Future studies are needed to further analyze the impact of stage and treatment modalities.

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EFFECTS OF FEMALE SEX HORMONES AND CONTRACEPTIVE PILL ON THE DIAGNOSTIC WORK-UP FOR PRIMARY ALDOSTERONISM: PP.18.181

Journal of Hypertension ◽

10.1097/01.hjh.0000379107.83919.42 ◽

2010 ◽

Vol 28 ◽

pp. e303-e304

Author(s):

F Pizzolo ◽

R Raffaelli ◽

A Memmo ◽

L Chiecchi ◽

C Pavan ◽

...

Keyword(s):

Sex Hormones ◽

Primary Aldosteronism ◽

Contraceptive Pill ◽

Female Sex ◽

Female Sex Hormones ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

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6.2 Comparison of Three Different Doses of ACTH Stimulation During Adrenal Vein Sampling (AVS) in the Work-Up of Primary Aldosteronism

High Blood Pressure & Cardiovascular Prevention ◽

10.1007/bf03263649 ◽

2008 ◽

Vol 15 (3) ◽

pp. 237-237

Author(s):

M. Seccia ◽

D. Miotto ◽

F. Mantero ◽

G. Pitter ◽

A. Patalano ◽

...

Keyword(s):

Primary Aldosteronism ◽

Adrenal Vein ◽

Acth Stimulation ◽

Adrenal Vein Sampling ◽

Work Up ◽

Different Doses

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Rapid Cortisol Assay during Adrenal Vein Sampling in Patients with Primary Aldosteronism

Clinical Chemistry ◽

10.1373/clinchem.2007.092080 ◽

2007 ◽

Vol 53 (11) ◽

pp. 1968-1971 ◽

Cited By ~ 65

Author(s):

Giulio Mengozzi ◽

Denis Rossato ◽

Chiara Bertello ◽

Corrado Garrone ◽

Alberto Milan ◽

...

Keyword(s):

Primary Aldosteronism ◽

Vena Cava ◽

Cost Effective ◽

Secondary Hypertension ◽

Sampling Procedure ◽

Standard Test ◽

Adrenal Vein ◽

Adrenal Vein Sampling ◽

Bilateral Adrenal Hyperplasia ◽

Service Oriented

Abstract Background: Adrenal vein sampling is considered the gold standard test to identify primary aldosteronism, the most frequent form of secondary hypertension. Technical difficulties with this procedure may be overcome by monitoring cortisol concentrations in the different sampling sites during catheterization. Methods: We applied a rapid automated cortisol assay performed on a benchtop immunoassay analyzer near the operating suite during the catheterization procedures in 5 hypertensive patients. A mean of 7.8 samples (range, 5–13) were collected from the vena cava as well as from right and left adrenal veins. Results: Cortisol concentrations measured by the rapid assay and by our routine method were comparable. Two of 5 patients were found to be affected by an aldosterone-producing adenoma and 3 of 5 by a bilateral adrenal hyperplasia. Cortisol determination during the adrenal vein sampling procedure allowed a successful cannulation in all patients, including a patient in whom it was necessary to cannulate 9 different candidate right adrenal veins before finding the correct one. Conclusions: Intraoperative cortisol assays appeared safe, reproducible, simple to perform, rapid, and cost-effective. The approach represents a service-oriented model for the laboratory and can provide valuable and timely information for improving the success rate of adrenal vein catheterization.

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Safety of medical adjustment and confirmatory testing in the diagnostic work-up of primary aldosteronism

Acta Endocrinologica ◽

10.1530/eje-19-0138 ◽

2019 ◽

Vol 181 (4) ◽

pp. 421-428 ◽

Cited By ~ 2

Author(s):

Daniel A Heinrich ◽

Christian Adolf ◽

Marcus Quinkler ◽

Finn Holler ◽

Benjamin Lechner ◽

...

Keyword(s):

Blood Pressure ◽

Side Effects ◽

Primary Aldosteronism ◽

Challenge Test ◽

Confirmatory Testing ◽

Defined Daily Doses ◽

Diagnostic Work ◽

Study Participants ◽

Work Up ◽

Diagnostic Work Up

Objective Saline infusion test (SIT) and captopril challenge test (CCT) are standard confirmatory procedures routinely used in the diagnostic work-up of primary aldosteronism (PA). However, side effects and complications during testing have not been systematically studied. Design We performed a cohort study with patients undergoing SIT and/or CCT in two centers from 2016 until 2018. Methods We studied 272 study participants with suspected PA enrolled at two outpatient centers in Germany. We assessed the frequency and severity of side effects during adjustment of blood pressure medication and during SIT and CCT. Results During the adjustment phase prior confirmatory testing, side effects including palpitations, headaches, edema and hypertensive episodes occurred in 18.4% of study participants. Side effects were associated with higher defined daily doses (DDD) (r = 0.25, P < 0.005), number of antihypertensive drugs (r = 0.285, P < 0.005) and higher blood pressure (r = 0.145, P = 0.019). During SIT, 17.5% of study participants had side effects, associated with higher blood pressure (systolic: r = 0.541, P < 0.0005; diastolic: r = 0.426, P < 0.0005) and DDDs (r = 0.727, P < 0.0005). During CCT, only 1.5% of study participants developed side effects. Conclusions In contrast to the high rate of side effects during SIT, CCT appears to be the safer test with a very low event rate. This makes CCT especially suitable for severely hypertensive patients.

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Effects of female sex hormones and contraceptive pill on the diagnostic work-up for primary aldosteronism

Journal of Hypertension ◽

10.1097/hjh.0b013e32833266e3 ◽

2010 ◽

Vol 28 (1) ◽

pp. 135-142 ◽

Cited By ~ 30

Author(s):

Francesca Pizzolo ◽

Ricciarda Raffaelli ◽

Alessia Memmo ◽

Laura Chiecchi ◽

Chiara Pavan ◽

...

Keyword(s):

Sex Hormones ◽

Primary Aldosteronism ◽

Contraceptive Pill ◽

Female Sex ◽

Female Sex Hormones ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

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Use of Ultrasound in the Diagnostic Work-Up of Adult Intussusception – A Multicenter Retrospective Analysis

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-0604-2676 ◽

2018 ◽

Vol 41 (04) ◽

pp. 418-427

Author(s):

Christoph Klinger ◽

Bettina Riecken ◽

Christoph Frank Dietrich ◽

Klaus Dirks ◽

Karel Caca ◽

...

Keyword(s):

Imaging Modality ◽

Basic Skills ◽

Adult Intussusception ◽

Ultrasound Computed Tomography ◽

Line Imaging ◽

Us Findings ◽

Diagnostic Work ◽

The Impact ◽

Work Up ◽

Diagnostic Work Up

Abstract Purpose To evaluate the use of ultrasound (US) in the diagnostic work-up of adult intussusception (AI). Methods This multicenter study includes 26 consecutive patients diagnosed with AI between January 2010 and November 2017. A retrospective chart analysis was conducted with a focus on abdominal US findings and diagnostic accuracy of different imaging modalities (ultrasound, computed tomography (CT), magnetic resonance imaging). If available, surgical and pathological findings served as the gold standard (76.9 %). US examiners certified according to DEGUM grade 2 or 3 were classified as experts. Otherwise, they were regarded to have basic skills. Results During diagnostic work-up, 92.3 % underwent abdominal US. US was the first-line imaging modality in 88.5 % of cases. The accuracy regarding the detection of AI (85 %), correct localization (95 %) and detection of complications (100 %) was excellent and comparable with CT (81 %, 90.5 %, and 91.7 %) when performed by experts. 72.7 % of tumorous lead points were detected by experienced examiners. In contrast, AI was detected in only 45.5 % of cases by examiners with basic skills. AI was diagnosed prior to surgery in all patients. Conclusion US is reliable in the diagnostic work-up of AI when performed by experienced examiners with high-quality equipment. US, CT and MRI should be used in a complementary fashion since combination provides excellent sensitivity regarding the detection and correct localization of AI as well as the detection of complications. The impact of real-time imaging is illustrated by supplementary videos.

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