Discriminative capacity of volumetry by CT scan to identify autonomous cortisol secretion in incidental adrenal adenomas

Context Incidentally discovered adrenal adenomas are common. Assessment for possible autonomous cortisol excess (ACS) is warranted for all adrenal adenomas given the association with increased cardiometabolic disease. Objective To evaluate the discriminatory capacity of three-dimensional volumetry on computed tomography (CT) to identify ACS. Design, Setting, Patients Two radiologists, blinded to hormonal levels, prospectively analyzed CT images on 149 adult patients with unilateral, incidentally-discovered, adrenal adenomas. Main Outcome Measures Diameter and volumetry of the adenoma, volumetry of the contralateral adrenal gland, and the adenoma volume-to-contralateral gland volume (AV/CV) ratio were measured. ACS was defined as cortisol≥1.8 mcg/dL after 1mg dexamethasone suppression test (DST) and a morning ACTH ≤15 pg/mL. Results We observed that ACS was diagnosed in 35 (23.4%) patients. Cortisol post-DST was positively correlated with adenoma diameter and volume, and inversely correlated with contralateral adrenal gland volume. Cortisol post-DST was positively correlated with the AV/CV ratio (r=0.46, p<0.001) and ACTH was inversely correlated (r=-0.28, p<0.001). The AV/CV ratio displayed the highest Odds Ratio (1.40 CI 95% 1.18-1.65) and area under curve (0.91 CI 95% 0.86-0.96) for predicting ACS. An AV/CV ratio ≥1 (48% of the cohort) had a sensitivity of 97% and a specificity of 70% to identify ACS. Conclusions CT volumetry of adrenal adenomas and contralateral adrenal glands has a high discriminatory capacity to identify ACS. The combination of this simple and low-cost radiological phenotyping can supplement biochemical testing to substantially improve the identification of ACS.

A COMPARATIVE STUDY OF FETAL ADRENAL GLAND BIOMETRY AND CERVICAL LENGTH AS A PREDICTOR OF PRETERM BIRTH

Background: Preterm birth is an important challenge in obstetrics and contemporary perinatology in India. Timely recognition, intervention and appropriate management is integral in curbing the upsurge in its incidence and consequent poor perinatal outcome. This study was conducted taking into account the potential mechanism of preterm labor: premature activation of the placental-adrenal endocrine axis wherein elevation of maternal cortisol leads to an increased production of placental corticotrophin releasing hormone which causes an increase in dehydroepiandrosterone produced by the fetal zone of the adrenal gland and its enlargement. This activates a cascade leading to early loss of uterine quiescence, consequently causing cervical modelling, ripening and preterm birth. Aim and Objectives: To assess fetal adrenal gland volume, fetal zone enlargement and cervical length on ultrasound and compare their efficacy in the prediction of preterm birth. Methods: This was a hospital based prospective study in which pregnant women with an uncomplicated live singleton pregnancy between 28 to 34 weeks of gestation were subjected to obstetric ultrasonography wherein fetal adrenal gland volume, fetal zone enlargement and cervical length was measured. They were then followed up until their delivery, whether term or preterm and its correlation with fetal adrenal gland parameters and cervical length was assessed. Result: Corrected fetal adrenal gland volume showed the highest sensitivity of 90.0% and a specificity of 96.7% with a cut off value of 632.50 mm3/kg while fetal zone enlargement showed a sensitivity and specificity of 72.7% and 60.9% respectively. Cervical length was found to be the least important marker for predicting the preterm birth as having the least AUC as 0.209, sensitivity as 36.4 % and specificity as 76.1%. Conclusion: This study concludes that fetal adrenal gland biometry can be used as a noninvasive, cost effective and potential new marker for the prediction of preterm birth and is a better predictor than cervical length. Keywords: Preterm, Cervical length, Adrenal biometry.

FETAL ADRENAL GLAND BIOMETRY: A POTENTIAL PREDICTOR OF PRETERM BIRTH

Background: Preterm birth is an important challenge in obstetrics and contemporary perinatology in India. Timely recognition, intervention and appropriate management is integral in curbing the upsurge in its incidence and consequent poor perinatal outcome. This study was conducted taking into account the potential mechanism of preterm labor: premature activation of the placental-adrenal endocrine axis wherein elevation of maternal cortisol leads to an increased production of placental corticotrophin releasing hormone which causes an increase in dehydroepiandrosterone produced by the fetal zone of the adrenal gland and its enlargement. This activates a cascade leading to early loss of uterine quiescence, consequently causing cervical modelling, ripening and preterm birth. Aim and Objectives: To assess fetal adrenal gland volume and fetal zone enlargement on ultrasound and evaluate its efficacy in the prediction of preterm birth. Methods: This was a hospital based prospective study in which pregnant women with an uncomplicated live singleton pregnancy between 28 to 34 weeks of gestation were subjected to obstetric ultrasonography wherein fetal adrenal gland volume and fetal zone enlargement was measured. They were then followed up until their delivery, whether term or preterm and its correlation with fetal adrenal gland parameters was assessed. Result: Corrected fetal adrenal gland volume showed the highest sensitivity of 90.0% and a specificity of 96.7% with a cut off value of 632.50 mm3/kg while fetal zone enlargement showed a sensitivity and specificity of 72.7% and 60.9% respectively. Conclusion: This study concludes that fetal adrenal gland biometry can be used as a noninvasive, cost effective and potential new marker for the prediction of preterm birth.

ULTRASOUND ASSESSMENT OF FETALADRENAL GLAND VOLUME (FAGV) AND ADRENAL FETAL ZONE ENLARGEMENT(AFZE):VIABLE AND SUPERIOR ALTERNATIVES TO CERVICAL LENGTH (CL) IN ACCURATE PREDICTION OF PRETERM BIRTHS.

BACKGROUND: Owing to associated neonatal death, morbidity and impairment in later life, preterm birth is a major public health issue. Pregnant ladies presenting to the antenatal clinic were recruited in order to predict spontaneous preterm births bythe novel method of assessing the Fetal Adrenal Gland Volume (FAGV) and Adrenal Fetal ZoneEnlargement(AFZE) and comparing it with Cervical length. MATERIAL AND METHODS:This was a prospective observational study done at a tertiary hospital in Chennai.The formulae,AFZE=Gland length/Central fetal zone length and FAGV=0.523 x length x width x depth. cFAGV=fetal adrenal gland volume/estimated fetal weight =FAGV/EFW, were employed for the purpose of this study.𝛘2 or Fisher’s exact tests,Mann-Whitney or student-t test were calculated for appropriate variables. Pregnant women with uncomplicated pregnancy with gestational age between 21-34 weeks were recruited for this study. RESULTS:70 pregnant women were studied from May2019 to August 2020 and had an average age of 25 years and mean age of gestation being 27.1 weeks.26(37.1%) of these had a preterm delivery of ≤7 days.AFZE emerged as the best predictor among the three metrics with sensitivity of 100% and specificity of ~90 %.cFAGV showed ~80%/~89% sensitivity and specificity.This was in contrast to cervical length of ≤16 mm having just 55% and 60% sensitivity and specificity respectively. SUMMARY:USG estimation of AFZE and cFAGV are more reliable and accurate indicators than CL for spontaneous preterm delivery and can be used in the routine scanning of patients with early symptoms of preterm labour to plan the management more effectively.

MON-161 Body Weight Reduction Not Always Reduced Adrenal Gland Volume in Obese Patients

Recent studies have shown that obesity is a major risk factor for idiopathic hyperaldosteronism (IHA). IHA patients have greater AGV than normal controls. However, it is unclear whether such changes are caused by obesity and whether losing weight could reverse the morphological and functional abnormalities of the adrenal gland. This study was to investigate the association of obesity with adrenal gland volume (AGV) and the effects of weight loss on AGV. This study recruited obese patients (N=25) who underwent sleeve gastrectomy and age- and sex-matched normal-weight (N=25) and overweight healthy volunteers (HV) (N=21). Thin-slice computed tomography was used to evaluate adrenal morphological changes. AGV was measured semiautomatically based on the digital imaging and communications in medicine (DICOM) image. The effects of weight loss on AGV were evaluated in patients for one year or more after sleeve gastrectomy. The results showed that left, right and total AGV were larger in obese patients than those in overweight and normal- weight HVs (6.77±0.36, 5.76±0.31, and 12.53±0.64 cm3 vs. 3.88±0.14, 3.09± 0.13 and 6.97± 0.24 cm3 vs. 3.38±0.23, 2.67±0.15 and 6.04±0.36 cm3). No statistically significant difference was identified between overweight and normal-weight HVs. Sleeve gastrectomy significantly reduced body weight (-27.1±2.5 kg), left AGV (-0.80±0.26 cm3), and right AGV (-0.88±0.20 cm2). However, the adrenal volume in five patients was not reduced, despite significant weight loss postsurgery. In brief, obesity leads to increased AGV, and in some cases, this effect seems to be irreversible. We speculate that obesity causes permanently adrenal morphological changes (increased volume or hyperplasia), and under certain circumstances, it results in excessive aldosterone secretion via altered adipokines (leptin, CTRP1, etc.).

Predictive Accuracy of Three Dimensional Ultrasound Measurement of Fetal Adrenal Gland Volume in Preterm Labor Cases

Background Preterm birth is one of the major clinical problems in obstetrics and neonatology as it is associated with perinatal mortality, serious neonatal morbidity and in some cases childhood disability. It is reported that more than 80% of all neonatal mortality and morbidity is due to preterm birth. Objective In this study fetal adrenal gland volume and fetal zone measurement were used as a predictors for occurrence of labor in singleton pregnancies complicated by threatened preterm labor in comparison to cervical length and cervicovaginal fetal fibronectin. Methodology The study was carried out at Ain Shams University Maternity Hospital. The current study include 88 pregnant women who presented with symptoms or signs of threatened preterm labor (PTL). All women were subjected to full history taking, full general, abdominal, pelvic examination, in addition to ultrasound fetal biometry, measurement of cervical length, measurement of fetal fibronectin, fetal adrenal gland volume AGV and fetal zone acquisitions. Results Our results showed high statistically significant difference between the two groups of women regarding CL measurement, FZE and cAGV with P values < 0.001 suggesting that ultrasound examination of fetal adrenal gland and assessment of FZE at time of evaluation for symptoms of PTL may be clinically beneficial in predicting the occurrence of labor in pregnant women at risk of preterm labor. Conclusion Our results demonstrate that in women presenting with threatened preterm labor, cAGV and FZE measured by 3-dimensional ultrasound seem to be significant predictors of delivery within 7 days, when compared to CL and cervicovaginal fetal fibronectin.

Prediction of preterm birth by evaluating the fetal adrenal gland volume and blood flow: a pilot study

Background: The aim of the current study was to estimate the risk of preterm birth (delivery < 37 weeks of gestation) by evaluating the fetal adrenal gland volume and blood flow at Women’s Health Hospital, Assiut University, Egypt.Methods: A pilot prospective cohort study included pregnant women presented to our hospital with threatened preterm labor between December 2016 and May 2018. All women were recruited consecutively at the emergency unit of Women’s Health Hospital at Assiut University. The fetal adrenal gland volume was assessed using 3-dimensional images of the fetal adrenal with the aid of Virtual Organ Computer-Aided Analysis (VOCAL) software. Doppler evaluation of the fetal adrenal blood vessels was carried out. The RI, PI and S/D ratio was calculated for every case. The neonatal outcomes at delivery were assessed and compared with respect to the duration of actual delivery from the time of evaluation. The obtained data were analyzed by SPSS software (version 22.0) and p<0.05 was taken as the significant level.Results: The study included 30 pregnant women at the final analysis. Women were classified according to the time of actual delivery into two groups. Group (I, n=13) those who delivered within 7 days and group (II, n=17) those who delivered 7 days or more. No difference between both groups regarding the baseline characteristics. No difference regarding the mode of delivery (p=0.708). All Doppler indices were statistically in-different between both groups. The fetal adrenal gland volume was significantly lower in group II than group I (p=0.001). On ROC analysis, the area under the curve (AUC) for prediction of preterm birth based on the fetal adrenal gland volume was (AUC= 0.873). The ROC curve shows that the best cut off value using the volume was ≥0.461 with 76.92% sensitivity and 88.24% specificity for prediction of preterm birth with an overall accuracy of 83.3%.Conclusions: Fetal adrenal gland volume was identified as a significant predictor of delivery in pregnant women who had spontaneous preterm births with intact membranes.