The value method of selective blood sampling from the adrenal veins in the diagnosis ACTH-independent hypercortisolism against the background of bilateral adrenal hyperplasia

Introduction. Endogenous hypercorticism is a relatively rare pathological condition, while in terms of severity of the course and labor prognosis it has a significant place among all endocrinopathies.A clinical case. A clinical case of ACTH-independent hypercorticism (Itsenko-Cushing syndrome), as well as the complexity of its diagnosis and differential diagnosis, is presented. During the examination, bilateral adrenal hyperplasia was revealed. The lateralization of cortisol hyperproduction was determined by the method of comparative selective blood sampling from the adrenal veins and the inferior vena cava. In addition, as an additional test for the differential diagnosis of primary and secondary hypercorticism, the steroid profile of blood and urine was evaluated by HPLC, which confirmed the patient's ACTH-independent hypercortisolism (Itsenko-Cushing syndrome). Thanks to the use of the CVD method, it was possible to resolve the issue of the volume of surgical intervention and prevent possible unjustified bilateral adrenalectomy with hormonal inactive formation of the right adrenal gland. When conducting a comparative selective blood sampling from the adrenal veins (CVD) in order to determine lateralization with the "reference hormone" in this patient, androstenedione was selected, which was not previously described in the literature. Surgical treatment was performed and information about the patient's postoperative period was provided.Conclusions. The above clinical case demonstrates an algorithm for diagnosing the causes of hypercorticism, possible errors and the use of time-consuming and high-tech diagnostic methods. The importance of a multidisciplinary approach is also indicated, despite the isolated endocrine pathology.