Kristin Viste

Efficacy of adrenal venous sampling is increased by point of care cortisol analysis

Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedure may enhance the success rate. We invited 21 consecutive patients to participate in a study with intra-procedural point of care cortisol analysis. When this assay showed nonrepresentative sampling, new samples were drawn after redirection of the catheter. The study patients were compared using the 21 previous procedures. The intra-procedural cortisol assay increased the success rate from 10/21 patients in the historical cohort to 17/21 patients in the study group. In four of the 17 successful procedures, repeated samples needed to be drawn. Successful sampling at first attempt improved from the first seven to the last seven study patients. Point of care cortisol analysis during AVS improves success rate and reduces the need for reexaminations, in accordance with previous studies. Successful AVS is crucial when deciding which patients with PA will benefit from surgical treatment.

Adrenal venous sampling for assessment of autonomous cortisol secretion.

Context Autonomous cortisol secretion (ACS) can be unilateral or bilateral irrespective of the presence of an adrenal tumor. A reliable method to distinguish between unilateral and bilateral ACS is lacking. Objective Evaluate the use of adrenal venous sampling (AVS) to distinguish between unilateral and bilateral ACS. Design and Methods This was a prospective study of AVS in patients with adrenal tumors who received a diagnosis of ACS or adrenal Cushing syndrome (CS). Unilateral secretion was defined as >2.3-fold difference in cortisol levels between the two adrenal veins. Metanephrine levels were used to ascertain correct catheter position. Results were correlated with findings on CT and iodine-131-cholesterol scintigraphy. Results Thirty-nine patients underwent AVS; there were no complications. The procedure was inconclusive in six patients and repeated with success in one, giving a success rate of 85%, and leaving 34 procedures for evaluation (adrenal CS, n = 2; ACS, n = 32). Of 14 patients with bilateral tumors, 10 had bilateral and 4 had unilateral overproduction. Of 20 patients with unilateral tumors, 11 had lateralization to the side of the tumor and the remaining had bilateral secretion. Cholesterol scintigraphy findings were concordant with those of AVS in 13 of 18 cases (72%) and discordant in 5 (28%). Conclusion Laterality of ACS does not always correspond to findings on CT images. AVS is a safe and valuable tool for differentiation between unilateral and bilateral cortisol secretion and should be considered when operative treatment of ACS is a possibility.

Rehabilitering etter armamputasjon

Overvektskirurgi er den anbefalte behandlingen for personer med sykelig overvekt. For å få gode behandlingsresultater må pasienten klare å endre livsstil. – Vi antar at psykiatrisk vurdering og veiledning før og etter operasjonen er gunstig for pasienten, men vi vet lite om hvordan dette påvirker pasientens evne til å tilpasse seg behandling og vekttap, sier Haldis Økland Lier. Hun har studert effekten av veiledning med vekt på livsstilsendring og endringer i forekomst av psykiske lidelser og livskvalitet etter operasjonen. Deltakerne var 169 pasienter som ble henvist til operasjon ved Haugesund sjukehus. 49 deltok i veiledningsgrupper før og etter operasjonen. – Alt i alt viser studien at pasientene har bedre livskvalitet og bedre mental helse etter operasjonen. Vekttapet var betydelig. Nær halvparten av pasientene hadde en psykisk lidelse før operasjonen – ofte mild depresjon eller angst, sier Lier. – Det var en betydelig nedgang i forekomsten av psykiske lidelser ett år etter operasjonen – til ca. 18 %. De som var uten psykiske lidelser ett år etter operasjonen, rapporterte om livskvalitet på nivå med «folk flest». De som hadde sterk skamfølelse i tillegg til psykisk lidelse før operasjonen, hadde høyest risiko for psykisk lidelse etterpå. Hos disse var det lite bedring i livskvaliteten. Disse pasientene bør prioriteres for oppfølging, sier Lier. Pasienter som ikke ville delta i veiledningsgruppene, hadde høyere nivå av sosial fobi. Lier fant ingen forskjell i vekttap, spisevaner eller nivå av fysisk aktivitet mellom dem som hadde deltatt i veiledningsgruppe og dem som ikke hadde deltatt.