This study aimed to focus on the role of radiologists in the diagnosis and management of adrenal lesions, particularly primary aldosteronism (PA) and secondary hypertension. As hypertension affects more than one-third of the population in Japan, identifying secondary causes such as PA and adrenal lesions is crucial. Establishing a radiological differential diagnosis of adrenal lesions using advanced imaging techniques, such as computed tomography and magnetic resonance imaging, is crucial. Knowledge of the imaging findings of various benign and malignant adrenal lesions, such as adrenocortical adenomas, cortisol-producing lesions, pheochromocytomas, adrenocortical carcinoma, malignant lymphoma, and metastatic tumors, is necessary. Adrenal venous sampling (AVS) plays a crucial role in accurately localizing aldosterone hypersecretion in PA, especially when imaging fails to provide a clear diagnosis. This paper details the technical aspects of AVS, emphasizing catheterization techniques, anatomical considerations, and the importance of preprocedural imaging for successful sampling. Furthermore, we explore segmental adrenal venous sampling (SAVS), a more refined technique that samples specific adrenal tributary veins, offering enhanced diagnostic accuracy, particularly for microadenomas or challenging cases that may be missed with conventional AVS. The methodology for performing SAVS, along with the interpretation criteria for successful sampling and lateralization, is also outlined. Furthermore, radiologists have initiated treatments for unilateral PA, such as radiofrequency ablation, and play an integral role in the management of adrenal lesions. Collaborative approaches across clinical departments are required to enhance patient management in medical care involving the adrenal gland.
Recommendation from the Editor in Chief
Radiographic diagnosis and therapeutic approach are
requisite for clinics of endocrinology, especially for a series of adrenal
diseases. From the unique standpoint of proficient radiologist, Dr. Oguro and
colleague contribute a comprehensive and extensive review article focusing on
this issue with a particular emphasis on segmental adrenal venous sampling
(SAVS) and radiofrequency ablation for the treatment of unilateral primary aldosteronism
(PA), shedding light on the importance of collaborative approach toward intractable
endocrine diseases.
Almost a century has passed since Plummer reported the efficacy of short-term preoperative inorganic iodine therapy for Graves’ disease in the 1920s. Since there were concerns about the escape phenomenon and exacerbation with inorganic iodine, antithyroid drugs became the mainstay of pharmacotherapy for Graves’ disease following their development in the 1940s. With regard to long-term inorganic iodine monotherapy, Trousseau reported a case in the 1860s, and several subsequent reports suggested its efficacy. Around 1930, Thompson et al. published a number of papers and concluded that long-term inorganic iodine monotherapy was useful if limited to mild cases under careful follow-up. From Japan, in 1970, Nagataki et al. reported that, of 12 patients treated with inorganic iodine, three remained eumetabolic for more than two years. Since 2014, some reports have also been published from Japan. A summary of these recent reports is given below. The starting dose of potassium iodide is around 50 mg/day, and candidate responders have mild disease, with FT4 <2.76 ng/dL (35.5 pmol/L), a small goiter, and are female and elderly. Response rates are relatively high, at 60–80%, and the remission rate is about 40%. In cases of insufficient response, changing therapy should be considered. Inorganic iodine can be used as a possible alternative if the patient experiences adverse events with antithyroid drugs and/or prefers conservative treatments, with an understanding of their efficacy and limitations. These recent reports have been published from Japan, where iodine is sufficient, and the dose of inorganic iodine is empirical and requires further study.
Recommendation from the Editor in Chief
It has been well recognized that inorganic iodine persistently suppresses thyroid function in some cases with Graves’ disease, and can be introduced as an alternative for patients with adverse events on antithyroid drugs. However, scientific bases are not fully elucidated and still remains empirical. In this issue, Dr. Natsuko Watanabe, an editorial board member of Endocrine Journal (EJ), contributes a well-organized, insightful narrative review focusing on this issue. The editorial team of EJ has a firm belief that all readers will be fascinated by an implicative “historical tale” around the relation between iodine and thyroid.
Cushing’s disease is associated with increased morbidity and mortality. Osilodrostat, a potent oral 11β-hydroxylase inhibitor, provided rapid, sustained mean urinary free cortisol (mUFC) normalization in Cushing’s disease patients in two Phase III studies (LINC 3, NCT02180217; LINC 4, NCT02697734). Here, we evaluate the efficacy and safety of osilodrostat in Cushing’s disease in patients of Asian origin compared with patients of non-Asian origin. Pooled data from LINC 3 and LINC 4 were analyzed. Outcomes were evaluated separately for Asian and non-Asian patients. For the analysis, 210 patients were included; 56 (27%) were of Asian origin. Median (minimum–maximum) osilodrostat dose was 3.8 (1–25) and 7.3 (1–47) mg/day in Asian and non-Asian patients, respectively. mUFC control was achieved at weeks 48 and 72 in 64.3% and 68.1% of Asian and 68.2% and 75.8% of non-Asian patients. Improvements in cardiovascular and metabolic-related parameters, physical manifestations of hypercortisolism, and quality of life were similar in both groups. Most common adverse events (AEs) were adrenal insufficiency (44.6%) in Asian and nausea (45.5%) in non-Asian patients. AEs related to hypocortisolism and pituitary tumor enlargement occurred in more Asian (58.9% and 21.4%) than non-Asian patients (40.3% and 9.1%). Of Asian and non-Asian patients, 23.2% and 13.6%, respectively, discontinued because of AEs. Asian patients with Cushing’s disease generally required numerically lower osilodrostat doses than non-Asian patients to achieve beneficial effects. Hypocortisolism-related AEs were reported in more Asian than non-Asian patients. Together, these findings suggest that Asian patients are more sensitive to osilodrostat than non-Asian patients.
Recommendation from the Editor in Chief
Ethnicity-dependent differences in drug responsiveness have attracted
broad attention also in endocrinological science. In this issue, Dr.
Akira Shimatsu and Professor Beverly MK Biller at Massachusetts General
Hospital, an active member of international honorary editors of
Endocrine Journal, contribute an insightful original article focusing on
ethnicity-related impact of oral 11beta-hydroxylase inhibitor,
Osilodrostat between patients with Cushing’s disease of Asian and
non-Asian origin. In comparison with non-Asians, Asian patients required
apparently-lower doses of the drug to achieve clinical benefits,
whereas adverse events related with hypocortisolism were manifested in
Asians. As authors stated, this study is the first to compare the impact
of drug therapy for patients with Cushing’s disease between Asian and
non-Asian origin. Although ethnicity-dependent differences in
bioavailability of the drug would be involved, elucidation of the entire
picture is strongly anticipated.
Elevated Fulminant Index (FI), [plasma glucose (PG)/glycosylated hemoglobin A1c (HbA1c)], was reportedly a sensitive index to differentiate fulminant type 1 diabetes (FT1D) from non-fulminant T1D (nFT1D). Aim of this study was to describe a better, but simpler index of FT1D. 49 and 52 patients with FT1D and nFT1D, respectively, were registered, and the discriminating ability of the rounded, normalized ratio, [PG (mmol/L) – 5.0]/[HbA1c (%) – 5.0], and the original ratio, [PG (mmol/L)]/[HbA1c (%)], was compared. Normalizing the ratio significantly raised its accuracy: area under the curve for receiver operating curve, AUROC (95%CI), 0.927 (0.858–0.964) and 0.851 (0.763–0.910), respectively, with and without the normalization (p < 0.01). Rounding of the figure into [PG (mmol/L) – 5.0]/[HbA1c (%) – 5.0] did not significantly sacrifice the discriminating ability of the index. Namely, the optimal cut point of rounded and normalized GAR, 10.0, showed 89.8% sensitivity. In conclusion, rounded, normalized (rn) GAR ≥10 (the rounded optimal cut-off) could be used for the snap diagnosis of FT1D.
Recommendation from the Editor in Chief
It is well recognized that patients with fulminant type 1 diabetes (FT1D), originally characterized by Professor Imagawa and Hanafusa et al, require expeditious diagnosis and successive intensive care. Inspired by the notion that incidence of FT1D in Caucasians has been extremely rare as compared to Asians, Dr. Mori and colleague propose the index beneficial for the snap diagnosis of FT1D in the November issue. Such a valuable suggestion is strongly anticipated to save lives of previously-undiagnosed FT1D worldwide.
A 38-year-old Japanese woman with a history of abnormal thyroid function of non-autoimmune origin, pituitary endocrine tumor, and untreated diabetes mellitus was referred to our outpatient clinic when she became pregnant with twins. Physical findings consistent with Cushing’s syndrome (CS) were absent at the time of presentation. Although baseline plasma adrenocorticotropic hormone, serum cortisol, and 24-hour urinary free cortisol excretion levels were above the upper limits of normal non-pregnant reference ranges, we could not exclude a physiological increase associated with pregnancy. No medical or surgical intervention for hypercortisolism was performed during pregnancy. Spontaneous vaginal delivery resulted in the normal delivery of live twins. A diagnosis of Cushing’s disease (CD) was established when papery skin developed postpartum. Transsphenoidal surgery was performed and the hypercortisolism partially resolved post-operatively. The patient’s abnormal thyroid function also resolved. Pregnancy in women with endogenous CS is rare, with less than 300 cases reported. Most reported cases of CS during pregnancy are of adrenal origin. Only two cases of twin pregnancies with CD have been reported. Therefore, we reported the third case of CD in a twin pregnancy and reviewed the diagnostic and therapeutic challenges associated with CD during pregnancy.
Recommendation from the Editor in Chief
Dr.
Hideyasu Asai and colleague report in the October issue an extremely rare case
of a pregnant woman with twins suffering from Cushing’s disease, exemplifying
hypercortisolism, hypothyroidism and diabetes. After the successful spontaneous
vaginal delivery, she received a transsphenoidal surgery, resulting in partial mitigation
of hypercortisolism and complete normalization of thyroid function, possibly
via the cancellation of cortisol-driven suppression of TSH as well as
conversion of T4 to T3. This in-depth case report on a rare situation coupled
with pregnancy and hyper ACTH in circulation provides us with fresh insight
into elaboration of endocrine networks throughout the body.
Effects of pre- and post-pubertal dihydrotestosterone treatment on penile length in 5α-reductase type 2 deficiency
Released on J-STAGE: September 28, 2019 | Volume 66 Issue 9 Pages 837-842
Goro Sasaki, Tomohiro Ishii, Naoaki Hori, Naoko Amano, Keiko Homma, Seiji Sato, Tomonobu Hasegawa
Views: 1,414
Effect of oral administration of nicotinamide mononucleotide on clinical parameters and nicotinamide metabolite levels in healthy Japanese men
Released on J-STAGE: November 02, 2019 |
Article ID EJ19-0313
Junichiro Irie, Emi Inagaki, Masataka Fujita, Hideaki Nakaya, Masanori Mitsuishi, Shintaro Yamaguchi, Kazuya Yamashita, Shuhei Shigaki, Takashi Ono, Hideo Yukioka, Hideyuki Okano, Yo-ichi Nabeshima, Shin-ichiro Imai, Masato Yasui, Kazuo Tsubota, Hiroshi Itoh
Views: 1,258
Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis
Released on J-STAGE: January 28, 2019 | Volume 66 Issue 1 Pages 51-63
Yaping Liang, Xiaojia Xu, Mingjuan Yin, Yan Zhang, Lingfeng Huang, Ruoling Chen, Jindong Ni
Views: 745
Comprehensive analysis of the safety of semaglutide in type 2 diabetes: a meta-analysis of the SUSTAIN and PIONEER trials
Released on J-STAGE: June 28, 2021 | Volume 68 Issue 6 Pages 739-742
Dao-Gen Yin, Liang-Liang Ding, Hai-Rong Zhou, Mei Qiu, Xue-Yan Duan
Views: 700
The impact of testosterone in men’s health
Released on J-STAGE: July 28, 2023 | Volume 70 Issue 7 Pages 655-662
Hisamitsu Ide
Views: 513