The diagnosis of corticotropin (ACTH)-independent hypercortisolism with adrenal imaging that does not demonstrate unilateral or bilateral nodules should prompt consideration of bilateral micronodular hyperplasia (Table C.2). Primary pigmented nodular adrenocortical…
Bilateral macronodular adrenal hyperplasia (BMAH) is an uncommon cause of adrenal hypercortisolism. It is a progressive disease that may present with a spectrum of cortisol and aldosterone secretion. BMAH can…
## Management of corticotropin (ACTH)-independent hypercortisolism in patients with bilateral adrenal nodules depends on imaging findings (adenomas versus macronodular hyperplasia) and tumor size. Adrenal venous sampling (AVS) is useful in…
## Establishing corticotropin (ACTH) dependence is a crucial step in the diagnostic evaluation of hypercortisolism and relies on measurement of ACTH. In ACTH-dependent hypercortisolism, pituitary magnetic resonance imaging (MRI) is…
## It is a curious conundrum when adrenal venous sampling (AVS) is performed in a patient with primary aldosteronism (PA) and the aldosterone concentrations from both successfully sampled adrenal veins…
## Workup for corticotropin (ACTH)-independent hypercortisolism is required in any patient with an adrenal mass, regardless of symptoms of hormone excess. Adrenalectomy is the treatment of choice for a unilateral…
## Adrenal venous sampling (AVS) is technically demanding. The success rate of sampling both adrenal veins is ≈95% at centers of excellence. However, at medical centers with low AVS case…
## Mineralocorticoid receptor antagonists (MRAs) (e.g., spironolactone and eplerenone) prevent aldosterone from activating the receptor, resulting, sequentially, in sodium loss, a decrease in plasma volume, and an elevation in renin….
## Bilateral macronodular adrenal hyperplasia (BMAH) is typically a computed tomography (CT)-based diagnosis. When patients present with primary aldosteronism (PA) and BMAH is found on the CT scan, the aldosterone…
## Unlike aldosterone-producing adenomas (APAs) that can be <1 cm in diameter and cause the full syndrome of primary aldosteronism (PA), clinically important cortisol-secreting adenomas require a “big factory” (e.g.,…
