SEMPLOVANJE IZ ADRENALNIH VENA KOD BILATERALNIH ADRENALNIH TUMORA SA AUTONOMNOM HIPERKORTIZOLEMIJOM. (Bosnian)

ADRENAL VEIN SAMPLING IN BILATERAL ADRENAL TUMORS WITH AUTONOMOUS HYPERCORTISOLISM. (English)

Bilateral adrenal tumors are a rare pathology, increasingly detected due to the widespread use of diagnostic imaging procedures such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). These changes can be either malignant or benign, with the potential for autonomous hormone production. Historically, tuberculosis was a leading cause of bilateral adrenal changes due to lower socio-economic status and poor hygiene. In this case, the patient was diagnosed with hypertension at 38 years old, and initial considerations included secondary endocrine causes of hypertension, specifically primary aldosteronism. CT imaging revealed bilaterally enlarged adrenal glands with multiple nodular changes showing absolute and relative washout indices characteristic of adenomas, with the largest measuring 17 x 23 mm on the right and 21 x 23 mm on the left. The patient had a history of hypokalemia, with the lowest recorded potassium level being 3.3 mmol/L. She reported spontaneous bruising on her arms and legs and weight gain in the abdominal area. Testing indicated the presence of ACTH-independent hypercortisolism. To precisely localize cortisol hypersecretion, adrenal vein sampling (AVS) was performed. [ABSTRACT FROM AUTHOR]

Bilateralni adrenalni tumori predstavljaju retku patologiju, ali se sve češće otkrivaju zahvaljujući širokoj primeni dijagnostičkih vizuelizacionih procedura kao što su ultrazvuk, kompjuterizovana tomografija i magnetna rezonanca. Promene mogu da budu maligne ili benigne, ali i da imaju sposobnost autonomne proizvodnje hormona. Ranije je tuberkuloza bila jedan od vodećih uzročnika bilateralnih promena zbog nižeg socio-ekonomskog statusa i lošije higijene. Kod pacijentkinje je dijagnoza hipertenzije postavljena u njenoj 38. godini, inicijalno je razmišljano u pravcu sekundarnih endokrinoloških uzročnika hipertenzije, tj. primarnog aldosteronizma. Kompjuterizovanom tomografijom su opisane obostrano uvećane nadbubrežne žlezde, sa više nodularnih promena apsolutnog i relativnog wash-out indeksa karakterističnog za adenom, od kojih je najveća veličine: desno 17x23 mm i levo 21x23 mm. Najniže vrednosti kalijuma su bile do 3.3 mmol/L. Navodi da joj se javljaju spontane modrice na rukama i nogama, kao i da se goji u stomačnom delu. Učinjeno je testiranje kojim je zaključeno da kod pacijentkinje postoji ACTH-nezavisni hiperkorticizam. Zbog precizne lokalizacije hiperprodukcije kortizola učinjeno je semplovanje adrenalnih vena. [ABSTRACT FROM AUTHOR]

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