Relevance of Endoscopic Ultrasound in Endocrinology Today: Multiple Endocrine Neoplasia Type 1, Insulinoma, Primary Aldosteronism—An Expert’s Perspective Based on Three Decades of Scientific and Clinical Experience
Abstract
:Simple Summary
Abstract
1. Introduction
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- assessment of the pancreatic and adrenal manifestations of multiple endocrine neoplasia type 1 (MEN1);
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- localization of insulinoma including planning adequate surgical strategy;
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- detection and localization or even exclusion of aldosterone-producing adenomas (APA, Conn’s adenomas) and defining adequate therapeutic strategy.
2. Multiple Endocrine Neoplasia Type 1
3. Insulinoma
4. Primary Aldosteronism
- Positive screening/case finding test for PA, i.e., positive aldosterone/renin ratio (A/R) [45], and high serum/plasma aldosterone concentration as suggested by Young [53]; or in early times, in which the A/R had not been established, an elevated aldosterone level with renin concentration in the low normal range was accepted. If the analysis had been performed in our laboratory (supine blood sampling after 30 min bed rest), cutoff for A/R had been defined as 3.8, and high aldosterone serum concentration as ≥ 15.0 ng/dL [53]. If aldosterone and/or renin analysis had not been performed in our laboratory, and the units used had not matched with our methods, cutoffs referring to the respective methods were used.
- Diagnosis of arterial hypertension, i.e., documented systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg [54], or prevalent antihypertensive medication before EUS imaging.
4.1. Saline Infusion Test (SIT)
4.2. Captopril Challenge Test (CCT)
4.3. Aldosterone and Aldosterone Metabolites in 24 h Urine Sampling
4.4. Computed Tomography (CT); Magnetic Resonance Imaging (MRI); Conventional Sonography (CS)
4.5. Selective Adrenal Vein Sampling (AVS)
4.6. Posture Stimulation Test (PST)
4.7. Endoscopic Ultrasound (EUS)
4.8. Definition of Aldosterone-Producing Adenoma (APA)
4.9. Data Analysis
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- diagnosis of adrenal adenoma by histopathology;
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- preoperatively serum or plasma aldosterone highly normal or above the normal range as described above with
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- elevated A/R;
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- or serum or plasma renin below the normal range or in the very low normal range (in early times when A/R has not been applied).
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- ≥50% of the following criteria as available needed to be fulfilled:
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- positive SIT or CCT;
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- elevated aldosterone or aldosterone metabolites in 24 h urine sampling;
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- positive lateralization in AVS;
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- documented postsurgical clinical improvement following suggestions by Vorselaars et al. [61], for this study defined by postoperative arterial normotension without antihypertensive treatment or reduced antihypertensive treatment;
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- postsurgical normalization of aldosterone and renin in serum or plasma.
4.9.1. Major Study Endpoint
4.9.2. Minor Study Endpoints
5. Results
6. Discussion
7. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Multiple Endocrine Neoplasia Type 1 | Detection of small tumors from 1–2 mm in diameter → defining “baseline morphology” of each lesion for follow-up. Precise assessment of tumor growth velocity (least significant change < 20% even in very small tumors). Detection of suspicious tumor morphology, morphological changes in follow-up. Detection of atypically fast growing tumors. Planning of surgical intervention:
|
Insulinoma | Localization of a pancreatic lesion typical of an insulinoma:
Planning of surgical intervention:
|
Primary Aldosteronism (Conn’s Adenoma) | Identification of an adrenal lesion with typical morphological features of an aldosteronoma. Defining the remaining parts of the ipsilateral and the contralateral adrenal as morphologically inconspicuous/normal. Planning of surgical intervention: selective adenomectomy possible? |
EUS | 89% | 39/44 | in four cases bilateral adenomas detected |
CT | 81% | 21/26 | |
MRT | 76% | 19/25 | +one falsely located in the contralateral adrenal |
CS | 32% | 6/19 | +two falsely located in the contralateral adrenal |
SAVS | 36% | 5/14 | selectivity index * <2 in 9 cases |
PST | 24% | 5/21 | referring to correct identification APA vs. IHA |
hypoechoic echogenicity | 82% |
largely homogenous echostructure | 72% |
hyperechoic capsular tumor margin | 93% |
termination of medullary echo at tumor margin | 97% |
diameter ≤ 2 cm | 77% |
no/only discrete hyperperfusion (duplex) | 94% |
tumors fulfilling at least four criteria | 98% |
tumors fulfilling at least five criteria | 91% |
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Kann, P.H. Relevance of Endoscopic Ultrasound in Endocrinology Today: Multiple Endocrine Neoplasia Type 1, Insulinoma, Primary Aldosteronism—An Expert’s Perspective Based on Three Decades of Scientific and Clinical Experience. Cancers 2023, 15, 3494. https://doi.org/10.3390/cancers15133494
Kann PH. Relevance of Endoscopic Ultrasound in Endocrinology Today: Multiple Endocrine Neoplasia Type 1, Insulinoma, Primary Aldosteronism—An Expert’s Perspective Based on Three Decades of Scientific and Clinical Experience. Cancers. 2023; 15(13):3494. https://doi.org/10.3390/cancers15133494
Chicago/Turabian StyleKann, Peter Herbert. 2023. "Relevance of Endoscopic Ultrasound in Endocrinology Today: Multiple Endocrine Neoplasia Type 1, Insulinoma, Primary Aldosteronism—An Expert’s Perspective Based on Three Decades of Scientific and Clinical Experience" Cancers 15, no. 13: 3494. https://doi.org/10.3390/cancers15133494