{"title":"Role of radiologists in the diagnosis and management of adrenal disorders.","authors":"Sota Oguro, Hiromitsu Tannai, Hideki Ota, Kazumasa Seiji, Hiroki Kamada, Yoshitaka Toyama, Kei Omata, Yuta Tezuka, Yoshikiyo Ono, Fumitoshi Satoh, Sadayoshi Ito, Tetsuhiro Tanaka, Hideki Katagiri, Kei Takase","doi":"10.1507/endocrj.EJ24-0156","DOIUrl":null,"url":null,"abstract":"<p><p>This study aimed to focus on the role of radiologists in the diagnosis and management of adrenal lesions, particularly primary aldosteronism (PA) and secondary hypertension. As hypertension affects more than one-third of the population in Japan, identifying secondary causes such as PA and adrenal lesions is crucial. Establishing a radiological differential diagnosis of adrenal lesions using advanced imaging techniques, such as computed tomography and magnetic resonance imaging, is crucial. Knowledge of the imaging findings of various benign and malignant adrenal lesions, such as adrenocortical adenomas, cortisol-producing lesions, pheochromocytomas, adrenocortical carcinoma, malignant lymphoma, and metastatic tumors, is necessary. Adrenal venous sampling (AVS) plays a crucial role in accurately localizing aldosterone hypersecretion in PA, especially when imaging fails to provide a clear diagnosis. This paper details the technical aspects of AVS, emphasizing catheterization techniques, anatomical considerations, and the importance of preprocedural imaging for successful sampling. Furthermore, we explore segmental adrenal venous sampling (SAVS), a more refined technique that samples specific adrenal tributary veins, offering enhanced diagnostic accuracy, particularly for microadenomas or challenging cases that may be missed with conventional AVS. The methodology for performing SAVS, along with the interpretation criteria for successful sampling and lateralization, is also outlined. Furthermore, radiologists have initiated treatments for unilateral PA, such as radiofrequency ablation, and play an integral role in the management of adrenal lesions. Collaborative approaches across clinical departments are required to enhance patient management in medical care involving the adrenal gland.</p>","PeriodicalId":11631,"journal":{"name":"Endocrine journal","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endocrine journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1507/endocrj.EJ24-0156","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
This study aimed to focus on the role of radiologists in the diagnosis and management of adrenal lesions, particularly primary aldosteronism (PA) and secondary hypertension. As hypertension affects more than one-third of the population in Japan, identifying secondary causes such as PA and adrenal lesions is crucial. Establishing a radiological differential diagnosis of adrenal lesions using advanced imaging techniques, such as computed tomography and magnetic resonance imaging, is crucial. Knowledge of the imaging findings of various benign and malignant adrenal lesions, such as adrenocortical adenomas, cortisol-producing lesions, pheochromocytomas, adrenocortical carcinoma, malignant lymphoma, and metastatic tumors, is necessary. Adrenal venous sampling (AVS) plays a crucial role in accurately localizing aldosterone hypersecretion in PA, especially when imaging fails to provide a clear diagnosis. This paper details the technical aspects of AVS, emphasizing catheterization techniques, anatomical considerations, and the importance of preprocedural imaging for successful sampling. Furthermore, we explore segmental adrenal venous sampling (SAVS), a more refined technique that samples specific adrenal tributary veins, offering enhanced diagnostic accuracy, particularly for microadenomas or challenging cases that may be missed with conventional AVS. The methodology for performing SAVS, along with the interpretation criteria for successful sampling and lateralization, is also outlined. Furthermore, radiologists have initiated treatments for unilateral PA, such as radiofrequency ablation, and play an integral role in the management of adrenal lesions. Collaborative approaches across clinical departments are required to enhance patient management in medical care involving the adrenal gland.
本研究旨在关注放射科医生在肾上腺病变,尤其是原发性醛固酮增多症(PA)和继发性高血压的诊断和管理中的作用。在日本,超过三分之一的人口患有高血压,因此识别继发性高血压(如 PA 和肾上腺病变)的病因至关重要。利用先进的成像技术(如计算机断层扫描和磁共振成像)对肾上腺病变进行放射学鉴别诊断至关重要。有必要了解肾上腺皮质腺瘤、皮质醇分泌性病变、嗜铬细胞瘤、肾上腺皮质癌、恶性淋巴瘤和转移性肿瘤等各种良性和恶性肾上腺病变的影像学检查结果。肾上腺静脉取样(AVS)在准确定位 PA 中的醛固酮分泌过多方面发挥着至关重要的作用,尤其是在影像学无法提供明确诊断的情况下。本文详细介绍了 AVS 的技术方面,强调了导管插入技术、解剖学注意事项以及术前成像对成功取样的重要性。此外,我们还探讨了节段性肾上腺静脉取样(SAVS),这是一种更精细的技术,可对特定的肾上腺支静脉进行取样,从而提高诊断的准确性,特别是对于微腺瘤或传统 AVS 可能会漏诊的疑难病例。此外,还概述了进行 SAVS 的方法以及成功取样和侧位的判读标准。此外,放射科医生已开始对单侧 PA 进行射频消融等治疗,并在肾上腺病变的治疗中发挥着不可或缺的作用。在涉及肾上腺的医疗护理中,需要跨临床科室的协作方法来加强对患者的管理。
期刊介绍:
Endocrine Journal is an open access, peer-reviewed online journal with a long history. This journal publishes peer-reviewed research articles in multifaceted fields of basic, translational and clinical endocrinology. Endocrine Journal provides a chance to exchange your ideas, concepts and scientific observations in any area of recent endocrinology. Manuscripts may be submitted as Original Articles, Notes, Rapid Communications or Review Articles. We have a rapid reviewing and editorial decision system and pay a special attention to our quick, truly scientific and frequently-citable publication. Please go through the link for author guideline.