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New types of localization methods for adrenocorticotropic hormone-dependent Cushing’s syndrome
Best Practice & Research Clinical Endocrinology & Metabolism ( IF 6.1 ) Pub Date : 2021-03-10 , DOI: 10.1016/j.beem.2021.101513
Russell Senanayake 1 , Daniel Gillett 1 , James MacFarlane 1 , Merel Van de Meulen 1 , Andrew Powlson 1 , Olympia Koulouri 1 , Ruth Casey 1 , Waiel Bashari 1 , Mark Gurnell 1
Affiliation  

The management of endogenous Cushing’s syndrome (CS) typically involves two key steps: (i) confirmation of autonomous hypercortisolism and (ii) localization of the cause to guide treatment. Adrenocorticotropic hormone (ACTH)-dependent CS is most commonly due to a pituitary corticotrope tumor which may be so small as to evade detection on conventional magnetic resonance imaging (MRI). Although biochemical testing (e.g., corticotropin stimulation; dexamethasone suppression) can provide an indication of the likely origin of ACTH excess, bilateral inferior petrosal sinus catheterization offers greater accuracy to distinguish pituitary-driven CS [Cushing’s Disease (CD)] from the ectopic ACTH syndrome [EAS, e.g., due to a bronchial or pancreatic neuroendocrine tumor (NET)]. In patients with CD, 40–50% may not have a pituitary adenoma (PA) readily visualized on standard clinical MRI. In these subjects, alternative MR sequences (e.g., dynamic, volumetric, fluid attenuation inversion recovery) and higher magnetic field strength (7T>3T>1.5T) may aid tumor localization but carry a risk of identifying coincidental (non-causative) pituitary lesions. Molecular imaging is therefore increasingly being deployed to detect small ACTH-secreting PA, with hybrid imaging [e.g., positron emission tomography (PET) combined with MRI] allowing precise anatomical localization of sites of radiotracer (e.g., 11C-methionine) uptake. Similarly, small ACTH-secreting NETs, missed on initial cross-sectional imaging, may be detected using PET tracers targeting abnormal glucose metabolism (e.g., 18F-fluorodeoxyglucose), somatostatin receptor (SSTR) expression (e.g., 68Ga-DOTATATE), amine precursor (e.g., 18F-DOPA) or amino acid (e.g., 11C-methionine) uptake. Therefore, modern management of ACTH-dependent CS should ideally be undertaken in specialist centers which have an array of cross-sectional and functional imaging techniques at their disposal.



中文翻译:

促肾上腺皮质激素依赖性库欣综合征的新型定位方法

内源性库欣综合症(CS)的治疗通常涉及两个关键步骤:(i)确认自主性高皮质功能亢进和(ii)确定病因以指导治疗。促肾上腺皮质激素(ACTH)依赖的CS最常见是由于垂体皮质激素瘤引起的,其可能很小,以至于无法通过常规磁共振成像(MRI)进行检测。尽管生化检查(例如促肾上腺皮质激素刺激,地塞米松抑制)可提供可能的ACTH过量的迹象,但双侧下颌窦窦导管插入术可更好地区分垂体驱动的CS [Cushing's Disease(CD)]与异位ACTH综合征[例如,由于支气管或胰腺神经内分泌肿瘤(NET)引起的EAS]。在患有CD的患者中,40–50%的垂体腺瘤(PA)可能无法在标准的MRI上轻易观察到。在这些受试者中,替代性MR序列(例如,动态,体积,液体衰减倒置恢复)和更高的磁场强度(7T> 3T> 1.5T)可能有助于肿瘤定位,但存在识别偶然性(非致因性)垂体病变的风险。因此,越来越多的分子成像技术被用于检测分泌出少量ACTH的PA,而混合成像技术(例如,与MRI相结合的正电子发射断层扫描(PET))可实现放射性示踪剂部位的精确解剖定位(例如,5T)可能有助于肿瘤定位,但冒着鉴别巧合性(非致病性)垂体病变的风险。因此,越来越多的分子成像技术被用于检测分泌出少量ACTH的PA,而混合成像技术(例如,与MRI相结合的正电子发射断层扫描(PET))可实现放射性示踪剂部位的精确解剖定位(例如,5T)可能有助于肿瘤定位,但冒着鉴别巧合性(非致病性)垂体病变的风险。因此,越来越多的分子成像技术被用于检测分泌出少量ACTH的PA,而混合成像技术(例如,与MRI相结合的正电子发射断层扫描(PET))可实现放射性示踪剂部位的精确解剖定位(例如,11 C-蛋氨酸)摄取。类似地,可以使用针对异常葡萄糖代谢(例如18 F-氟脱氧葡萄糖),生长抑素受体(SSTR)表达(例如68 Ga-DOTATATE)的PET示踪剂检测在初始横截面成像中遗漏的小的ACTH分泌网。胺前体(例如18 F-DOPA)或氨基酸(例如11 C-蛋氨酸)摄取。因此,理想情况下,应该在具有各种横截面和功能成像技术的专科中心对依赖ACTH的CS进行现代管理。

更新日期:2021-03-10
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