COVID-19 ja endokriiniset sairaudet

Vertaisarvioitu.Endokriinisista sairauksista etenkin diabetes, lihavuus ja APECED-oireyhtymä altistavat vaikealle COVID-19:lle. Hyperglykemia on haitallista myös ilman edeltävää diabetesdiagnoosia, ja sen hyvä hoito parantaa ennustetta. Vaikeaa koronaviruskeuhkoinfektiota sairastavilla on todettu pieniä veren D-vitamiinipitoisuuksia, mutta D-vitamiinilisien merkityksestä vaikean COVID-19:n ehkäisyssä odotetaan vielä lisätietoa. Koronavirusinfektioiden yhteydessä on kuvattu myös kilpirauhastulehduksia. Lisämunuaiskuoren vajaatoimintaan liittyy akuuttien sairauksien yhteydessä lisämunuaiskriisin riski. Toistaiseksi ei kuitenkaan ole näyttöä, että lisämunuaiskuoren vajaatoimintaa sairastavien COVID-19:n ennuste olisi huonompi kuin muiden. Myöskään neuroendokriiniset kasvaintaudit eivät tiettävästi huononna ennustetta, joskin solunsalpaajahoito voi lisätä COVID-19-potilaiden vaikean taudin riskiä. Diabetesta sairastavien, glukokortikoidihoitoa saavien ja ylipainoisten potilaiden osalta on erityisen tärkeää huolehtia laskimotukosten ehkäisystä.Peer reviewe

Lateralization in C-11-Metomidate PET and outcome of adrenalectomy in primary aldosteronism

Introduction Subtype classification method is essential when considering adrenalectomy as a possible treatment for primary aldosteronism. We aimed to retrospectively evaluate surgical outcomes of primary aldosteronism in patients who had undergone C-11-metomidate positron emission tomography (C-11-MTO-PET) for subtype classification. Methods Postoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative C-11-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on C-11-MTO-PET alone and those with concordant or discordant lateralization in C-11-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure. Results Adrenalectomy side was based on C-11-MTO-PET alone in 14 cases and on AVS in 30 cases of whom 42 achieved complete and two partial biochemical cures. Among those who underwent AVS and were operated according to it, the two lateralization methods were concordant in 22 cases and discordant in 8 cases. Similar immunohistochemical profiles and cure rates were seen after C-11-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant C-11-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with C-11-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery. Conclusions Outcomes of adrenalectomy based on clinically significant lateralization in C-11-MTO-PET alone correspond to those based on C-11-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with C-11-MTO-PET in case of discordant lateralization studies.Peer reviewe

Adrenal androgens versus cortisol for primary aldosteronism subtype determination in adrenal venous sampling

Objective We examined if measurement of adrenal androgens adds to subtype diagnostics of primary aldosteronism (PA) under cosyntropin-stimulated adrenal venous sampling (AVS). Design A prospective pre-specified secondary endpoint analysis of 49 patients with confirmed PA, of whom 29 underwent unilateral adrenalectomy with long-term follow-up. Methods Concentrations of androstenedione, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulphate (DHEAS) were measured during AVS in addition to aldosterone and cortisol. Subjects with lateralisation index (LI) of >= 4 were treated with unilateral adrenalectomy, and the immunohistochemical subtype was determined with CYP11B2 and CYP11B1 stains. The performance of adrenal androgens was evaluated by receiver operating characteristics (ROC) curve analyses in adrenalectomy and medical therapy groups. Results During AVS, the correlations between cortisol and androstenedione, DHEA and DHEAS for LI and selectivity index (SI) were highly significant. The right and left side SIs for androstenedione and DHEA were higher (p < .001) than for cortisol. In ROC analysis, the optimal LI cut-off values for androstenedione, DHEA and DHEAS were 4.2, 4.5 and 4.6, respectively. The performance of these LIs for adrenal androgens did not differ from that of cortisol. Conclusions Under cosyntropin-stimulated AVS, the measurement of androstenedione and DHEA did not improve the cannulation selectivity. The performance of cortisol and adrenal androgens are confirmatory but not superior to cortisol-based results in lateralisation diagnostics of PA.Peer reviewe

Lateralization in 11C-Metomidate PET and outcome of adrenalectomy in primary aldosteronism

IntroductionSubtype classification method is essential when considering adrenalectomy as a possible treatment for primary aldosteronism. We aimed to retrospectively evaluate surgical outcomes of primary aldosteronism in patients who had undergone 11C-metomidate positron emission tomography (11C-MTO-PET) for subtype classification.MethodsPostoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative 11C-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on 11C-MTO-PET alone and those with concordant or discordant lateralization in 11C-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure.ResultsAdrenalectomy side was based on 11C-MTO-PET alone in 14 cases and on AVS in 30 cases of whom 42 achieved complete and two partial biochemical cures. Among those who underwent AVS and were operated according to it, the two lateralization methods were concordant in 22 cases and discordant in 8 cases. Similar immunohistochemical profiles and cure rates were seen after 11C-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant 11C-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with 11C-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery.ConclusionsOutcomes of adrenalectomy based on clinically significant lateralization in 11C-MTO-PET alone correspond to those based on 11C-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with 11C-MTO-PET in case of discordant lateralization studies.</p

Aldosterone-to-renin ratio is related to arterial stiffness when the screening criteria of primary aldosteronism are not met

Aldosterone-to-renin ratio (ARR) is a screening tool for primary aldosteronism (PA), but the significance of ARR when the PA criteria are not met remains largely unknown. In this cross-sectional study we investigated the association of ARR with haemodynamic variables in 545 normotensive and never-medicated hypertensive subjects (267 men, 278 women, age range 19-72 years) without suspicion of PA. Supine haemodynamic data was recorded using whole-body impedance cardiography and radial tonometric pulse wave analysis. In sex-adjusted quartiles of ARR, determined as serum aldosterone to plasma renin activity ratio, the mean values were 282, 504, 744 and 1467 pmol/mu g of angiotensin I/h, respectively. The only difference in haemodynamic variables between the ARR quartiles was higher pulse wave velocity (PWV) in the highest quartile versus other quartiles (p=0.004), while no differences in blood pressure (BP), heart rate, wave reflections, cardiac output or systemic vascular resistance were observed between the quartiles. In linear regression analysis with stepwise elimination, ARR was an independent explanatory factor for PWV (beta =0.146, pPeer reviewe