Experience in the treatment of patients with ACTH-independent macronodular bilateral adrenal hyperplasia

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Abstract

Aim – to determine the optimal tactics for the examination and treatment of patients with macronadular bilateral adrenal hyperplasia.

Material and methods. The study included 11 patients with macronodular bilateral adrenal hyperplasia (main group). To compare biochemical parameters, the results of 26 healthy people were studied (control group).

Results. The patients with macronodular bilateral adrenal hyperplasia were characterized by deficiency of 11β-hydroxylase, 21-hydroxylase, 11β-hydroxysteroid dehydrogenase type 2 and increased activity of 5β-reductase compared with the control group. The optimal treatment for these patients is unilateral adrenalectomy. A comparative selective blood sampling from the central veins of the adrenals is necessary to select the side of intervention in patients with bilateral macronodular adrenal hyperplasia with ACTH-independent Cushing's syndrome.

Conclusion. The first step in the treatment of patients with bilateral macronodular adrenal hyperplasia with ACTH-independent Cushing's syndrome is unilateral adrenalectomy, which reduces the risk of developing adrenal insufficiency and subsequent hormone replacement therapy.

About the authors

Aleksandr A. Lisitcyn

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: 9213244516@mail.ru
ORCID iD: 0000-0003-2045-0044
SPIN-code: 3237-4309

PhD, Associate Professor of the Department of Faculty Surgery named after I.I. Grecov

Russian Federation, Saint Petersburg

Vyacheslav P. Zemlyanoi

North-Western State Medical University named after I.I. Mechnikov

Email: 9213244516@mail.ru
ORCID iD: 0000-0003-2329-0023

PhD, Professor, Head of the Department of Faculty Surgery named after I.I. Grekov

Russian Federation, Saint Petersburg

Sergei B. Shustov

North-Western State Medical University named after I.I. Mechnikov

Email: 9213244516@mail.ru
ORCID iD: 0000-0002-9075-8274

PhD, Professor, Head of the Adrenal Pathology Center

Russian Federation, Saint Petersburg

Lyudmila I. Velikanova

North-Western State Medical University named after I.I. Mechnikov

Email: 9213244516@mail.ru
ORCID iD: 0000-0002-9352-4035

PhD, Professor, Head of the Research Laboratory of Chromatography

Russian Federation, Saint Petersburg

Evgeniya M. Nesvit

North-Western State Medical University named after I.I. Mechnikov

Email: 9213244516@mail.ru
ORCID iD: 0000-0002-2612-1922

Surgeon

Russian Federation, Saint Petersburg

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2. Figure 1. Axial (1) and coronal (2) views of the right and left adrenal glands (native phase) with bilateral macronodular hyperplasia.

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3. Figure 2. Abdominal and retroperitoneal CT scan (axial view, native phase) and angiography of the right and left adrenal glands in a patient with bilateral macronodular adrenal hyperplasia with Cushing's syndrome.

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4. Figure 3. Аdrenal gland with macronodular hyperplasia: 1) view of the altered adrenal gland from the side of the capsule, 2) sectional view.

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Copyright (c) 2023 Lisitcyn A.A., Zemlyanoi V.P., Shustov S.B., Velikanova L.I., Nesvit E.M.

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