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Syndrome. See VIP-Oma of the Pancreas ACTH. See Adrenocorticot Index A occult tumors in, 52-53 Abdomen, computed tomography of, 29f, 30f, 51 Adrenogenital syndrome, 38 Achlorhydria (WDHR) syndrome. See VIP-oma of Aldosterone, effects of, 36 the pancreas Aldosterone and primary aldosteronism (Conn's ACTH. See Adrenocorticotropic hormone syndrome),155-159 Addison's disease, 31, 133 aldosterone suppression tests, 157-158 Adrenal carcinoma, arteriography of, 43f determination of plasma aldosterone precursors, Adrenal cortex 158 aldosterone-producing tumors of, 36 determination of plasma and urinary aldosterone diseases of, 33-38 levels, 156 Adrenal cortical carcinomas, 42-43 determination of plasma renin activity or Adrenal glands, 28-32 concentration, 155-156 adrenal scintigraphy in, 28 determination of plasma/serum electrolytes, 155 close interaction between gonads and, 21 individual basal levels, 158f computed tomography of, 28-30, 32 postural stimulation test, 156-157 in Cushing's disease, 35f response to spironolactone trial, 159 in macro nodular hyperplasia, 35 twenty-four-hour urinary aldosterone excretion magnetic resonance imaging (MRI) in, 30-32 rates, 158f malignant tumors of, 42-43 Aldosteronism, treatment of, 38 single adenoma of, 50f Aldosteronoma, in Conn's syndrome, 37f ultrasonography in, 28, 32 Amine-precursor uptake and decarboxylation venous sampling in, 32 (APUD),75 Adrenal hemorrhage, 31 Androgen-producing adrenal neoplasias, 162-163 Adrenal hormone excess, 36-38 Androgen-producing tumors, 38 Adrenal hyperplasia, 34f Androgen-secreting ovarian tumors, 25t Adrenal imaging, indications for, 28 Angiotensin I, 119 Adrenal medulla, diseases of, 39-44 Angiotensin II, 119 Adrenal scientigraphy, 28 APUD. See Amine-precursor uptake and Adrenal veins, anatomical variations and anomalies decarboxylation of,5f APUD cells, 87, Adrenocorticotropic hormone (ACTH) APUD concept, 17-78 in catheterization of IPS, 64-68 APUDomas, 78 in Cushing's syndrome, 33-36 Ascending lumbar vein, Ilf measuring, 52 Asymptomatic hyperparathyroidism, 167 178 Index B Computed tomography (CT) Basal metabolic rate (BMR), 41 of abdomen, 29f, 30f, 51 Basilar plexus, 56 in adrenal glands, 28-30, 32 B cells, 76 of cranium, 51 Beta cells (B cells), 76 in hyperandrogenemia, 4 Bilateral adrenal hyperplasia, 34f in hyperparathyroidism, 137 Bilateral adrenal metastases, 44f in islet cell localization, 90-91 Bilateral renal artery stenosis, 123 in pheochromocytomas, 40f Blind pancreaticoduodenectomy, 110 Congenital adrenal hyperplasia, 162 Breast cancer, 128 Conn's syndrome, 36-38 aldosteronoma of, 37f C Corticotropin releasing factor, 63 Calcitonin (thyrocalcitonin), 129 in elevated prolactin levels (PRL) , 67-68 Calcium, absorption of, 131 testing, in Conn's syndrome, 49-51 Calcium set point, 127 Corticotropin releasing hormone (CRH) stimulation Captopril, 121, 170 \ test, 165 Captopril challenge test, 121 Cortisol and Cushing's syndrome, 151-155 Catheterization "classic" dexamethasone suppression test accuracy of, 11 (Liddle's test), 154-155 clinical findings and peripheral androgen levels in determination of plasma/serum cortisol levels, 75women,3t 152-153 normal women and clinical results of, 14-17 determination of urinary free cortisol excretion in pancreatic venous sampling, 97-99 rate, 152 selective bilateral ovarian-adrenal individual serum cortisol levels, 153f, 154f catheterization, 24-25 overnight dexamethasone suppression test (DST) , stress factor and hormone release during 153-154 sampling, 13-14 Cortisol measurement, 49 Catheterization in hyperandrogenemia, 1-4 Cranial CT, 51 angiographic catheters in, 14f CRF. See Corticotropin releasing factor four-vessel blood sampling technique, 15f C-terminal fragments/assays, 134-135 hormone analysis, 14 Cushing's disease influence of contrast media on ho~mone release, bilateral adrenal hyperplasia in, 34f 12 causes of, 48 procedure, 8-10 CRFin, 63 side effects and complications of, 12-13 diagnostic problems in, 52-53 statistical analysis, 14 laboratory tests, 48-51 Catheterization in IPS, 58- 63 pituitary adenoma in, 50 access, 58-59 plasma ACTH levels in, 66f catheters, 58 plasma prolactin levels in, 65f, 66f contrast media, 58 problems with endocrinologic testing, 52-53 endocrinological background for, 63 problems with hormone measurements, 52 endocrinological results in, 64-66 problems with radiological procedures, 53 facts to keep in mind about, 66-68 radiological procedures, 51 patients and methods, 63-64 thrombosis in, 59 procedure, 59-62 Cushing's syndrome, 33-34, 43. See also Cortisol schematic drawing of sampling catheters entering and Cushing's syndrome inferior petrosal sinuses, 59f ,clinical workup, 34-36 side effects and complications of, 62-63 IPS catheterization in, 63-64 technical results, 64 plasma cortisol and ACTH levels in, 165f Cavernous sinuses, anatomy of, 54-56 serum cortisol and 11-deoxycortisol levels in, afiluents and efiluents of, 55-56 165f Cimetidine therapy, 109 Circumaortic venous ring, 12f D "Classic" dexamethasone suppression test (Liddle'S D cell, 76 test),154-155 Dehydroepiandrosterone sulfate (DHEA-S), 2 Index 179 Deoxycorticosterone acetate (DOCA) suppression H test, 157 Hepatic artery embolization, 112 Dexamethasone (DXM), in hyperandrogenemia, 2 Hepatic metastases, 82 Dexamethasone suppression test (DST), 2-4, Hepatic veins, 8t 154-155 High-dose dexamethasone tests, 49, 52 in Cushing's syndrome, 49 Hirsutism and virilization, 159-163 in idiopathic hirsutism, 161 androgen-producing adrenal and ovarian overnight test, 49, 153-154 neoplasias, 162-163 Diabetes-dermatitis syndrome, 82 causes of, 159 Diazoxide suppression test, 81 congenital adrenal hyperplasia (CAH), 162 Distal blind pancreatic resection, 110 idiopathic hirsutism, 160-161 Human pancreatic polypeptide (hPP), 76 E Humoral hypercalcemia of malignancy (HHM), Ectopic ACTH syndrome, 34, 50f, 164 134 CRFin,63 Hyperandrogenemia. See also Catheterization in dexamethasone suppressi\m test in, 49 hyperandrogenemia diagnosing, 52-53 anatomy and anatomical variations in, 4-8 Ectopic insulinomas, 109 causes of, 1 Ectopic ulcerogenic syndrome. See Gastrinoma clinical features, 2 Endocrine pancreatic tumor, 75 diagnostic methods for localization of androgen­ schematic representation of, 79f producing tumors, 4t Endocrinologic testing, problems with, 52-53 diagnostic procedures, 2-4 Extraadrenal pheochromocytomas (para­ effects of contrast media on adrenal steroid gangliomas), 39 release in, 16f Extraadrenal tumors, 39 endocrinologic results, 13-14 Extrapancreatic tumors, localizing, 96 estimation of secretion rates in, 1 indications, 4 F laboratory tests, 2-4 Familial hypocalciuric hypercalcemia, 126-127, 133 nontumorous, 17-21 Female hyperandrogenemia. See Hyperandrogenemia ovarian hyperthecosis, 22 Feminizing tumors, 38 physical examination in, 2 Functioning islet cell tumors, 75 polycystic ovary syndrome, 21-22 radiographic procedures for, 1 G standardized protocol for ovarian and adrenal Gastrin vein sampling, 4t and gastrinoma, 166-167 tumorous, 23-24 hormone assay, 167 Hypercalcemia Gastrinoma, 84-86, 166-167 causes of, 133t clinical features, 85 differential diagnosis of, 131-134 diagnosis, 85-86 effects of, 125 diagnostic workup, 85-86 familial hypocalciuric, 133 head/body/tail ratio in, 108-109 idiopathic hypocalciuria of infancy, 133 histologic and architectural data, 85 of malignancy, 127-128, 133 preoperative localization methods, 167 milk-alkali syndrome, 133 Gastrin secreting cells (G cells), 76 myeloma, 133 G cells, 76 other causes of, 133-134 Glucagon hormone assay, 167 primary hyperparathyroidism as cause of, Glucagonoma, 79, 82-83, 167 126-127 diagnostic workup, 82-83 secondary hypocalcemia and, 127-128 histologic and architectural data, 82 Hypercatecholaminism, 39-42 Glucose tolerance test, 81 Hypercortisolis,m, major clinical features of, 48 Gonadal neoplasms, 24f HypercortisolisI11us,33-36 Gonads clinical workup, 34-36 close interaction between adrenals and, 21 Cushing's disease, 33-34 radiation exposure to, 13 Cushing's syndrome, 33 180 Index Hyperinsulinism anatomy, 54~58 author's experience in, 114-115 functional anatomical aspects, 56-58 preoperative localization of pancreatic lesions hormonal concentrations in, 53 causing, 114t location and description of, 56 symptoms of, 81 sampling, reasons for performing, 53 Hyperparathyroidism (HPT) Inferior phrenic veins, 5, 6f catheter for upper part of right jugular vein, 140f Insulin clinical features, 125 hormone assay, 166 computed tomography (CT) in, 137 and insulinomas, 165-166 diagram for parathyroid sampling, 14lf production of, 76 extremely dilated right jugular vein, 14lf Insulinomas, 80-82, 165-166. See also Pancreatic four different catheters for parathyroid sampling, insulinoma blind distal pancreatectomy for, 110 139f categories of, 80-81 gadolinium (Gd)-D PTA enhanced Tl-weighted characteristics of, 80 spin-echo (SE) sequences, 138 clinical diagnosis of, 109 introduction, 125 1 clinical presentation of, 80 invasive diagnostic procedures, 138-144 clinical workup of, 166 magnetic resonance imaging (MRI) in, 137-138 diagnostic workup of, 81-82 noninvasive imaging in, 135-138 head/body/tail ratio of, 109 roadmapping of venous sampling, 140-141 histologic and architectural data, 80-81 scintigraphy in, 137 preoperative localization methods, 166 signs and symptoms, 125-126 Intraarterial DSA, 142-143 thermography in, 138 Intraoperative ultrasound, 96-97 treatment, 144-145 Intravenous dexamethasone, in Polycystic ovaries, ultrasound in, 135-137 22,23f venous sampling, 139-140 IPS. See Inferior petrosal
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