Diagnosis and Management of Endocrine Disorders in Interventional Radiology

Preface
Contents
Contributors
Part I: Clinical, Laboratory, and Radiological Diagnosis of Endocrine Disorders
	Chapter 1: Clinical, Laboratory, and Radiological Diagnosis of Primary Aldosteronism
		Introduction
		History
		Prevalence
		Hypokalemia and Primary Aldosteronism
			Case Detection: Who Should Be Tested?
			How to Test
			Interfering Medications
			Lab Interpretation
			Confirmatory Testing
		Radiological Diagnosis
		References
	Chapter 2: Clinical, Laboratory, and Radiological Diagnosis of Hyperparathyroidism
		Introduction
		Etiology
		Epidemiology
		Anatomy and Pathophysiology
			Parathyroid Gland Anatomy
			Physiologic Roles of Calcium and Organic Phosphate
			Regulation of Parathyroid Hormone in Response to Hypocalcemia
			Parathyroid Hormone Action on Bone
			Parathyroid Hormone Action on the Kidney
			Parathyroid Hormone Action on the Intestine
			Impact of Serum Phosphate
		Clinical Evaluation
			Historical Presentations
			Current Presentation of Classic Primary Hyperparathyroidism
			Normocalcemic Primary Hyperparathyroidism
		Laboratory Evaluation
			Initial Laboratory Testing
			Calcium
				Corrected Calcium
				Ionized Calcium
			Parathyroid Hormone Assays
				First Generation Assays
				Second- and Third-Generation Assays
			Measurement of Renal Function
			Serum Phosphate
			25-Hydroxyvitamin D (Vitamin D)
			24-Hour Urine Calcium
			Biochemical Stone Risk Analysis
			Markers of Bone Turnover
			Tests of Low Clinical Utility
				1,25-Dihydroxy Vitamin D (Calcitriol)
			Laboratory Interpretation and Differential Diagnosis
				Secondary Hyperparathyroidism
				Medication Effects
				Tertiary Hyperparathyroidism
				Familial Hypocalciuric Hypercalcemia
				Autoimmune Hypocalciuric Hypercalcemia
				Pseudohypoparathyroidism
			Genetic Evaluation for Primary Hyperparathyroidism
		Imaging Evaluation
			Radiographic Findings of Hyperparathyroidism
				Plain Radiography
				Dual-Energy X-ray Absorptiometry
				Vertebral Fracture Assessment by DEXA
				Trabecular Bone Score by DEXA
				High-Resolution Peripheral Quantitative CT
			Gland Localization
				Parathyroid Ultrasound
				SPECT-CT
				4D Neck CT
				Magnetic Resonance Imaging
		Indications for Procedural Intervention (Surgery or Ablation)
		Conclusions
		References
	Chapter 3: Clinical, Laboratory, and Radiological Diagnosis of Hyperandrogenism
		Introduction
		Etiology
		Epidemiology
		Pathophysiology
			Androgen Production by Endocrine Glands
			Androgen Production in Peripheral Tissues
		Clinical Evaluation
		Laboratory Evaluation
		Imaging Evaluation
		Conclusion
		References
	Chapter 4: Clinical, Laboratory, and Radiological Diagnosis of Hypercortisolism
		Introduction
		Etiology
		Epidemiology
		Pathophysiology
			Pituitary Corticotroph Adenomas: Cushing’s Disease
			Ectopic ACTH Syndrome
			Unilateral Adrenal Adenoma
			Adrenocortical Carcinoma
			Bilateral Adrenal Nodular Disease
		Clinical Evaluation
			Adipose and Skin
			Musculoskeletal
			Metabolic
			Cardiovascular
			Reproductive
			Immune
			Psychiatric
		Laboratory Evaluation
			Diagnosing Hypercortisolemia: 24-Hour Urine Free Cortisol
			Diagnosing Hypercortisolemia: Low-Dose Dexamethasone Suppression Test
			Diagnosing Hypercortisolemia: Late Night Salivary Free Cortisol
			Determining ACTH Status
			Determining the Etiology
		Imaging Evaluation
			ACTH-Secreting Pituitary Adenomas
			Ectopic ACTH Syndrome
				Thoracic Sources of Ectopic ACTH Production
				Abdominal Sources of Ectopic ACTH Production
			ACTH-Independent Hypercortisolism
		References
	Chapter 5: Clinical, Laboratory, and Radiological Diagnosis of Pancreatic Islet Cell Tumors
		Introduction
			Etiology/Physiology
			Epidemiology
		Insulinoma
			Etiology/Pathophysiology
			Epidemiology
			Clinical Evaluation
			Laboratory Evaluation
		Gastrinoma
			Etiology/Pathophysiology
			Epidemiology
			Clinical Evaluation
			Laboratory Evaluation
		Glucagonomas
			Etiology/Pathophysiology
			Epidemiology
			Clinical Evaluation
			Laboratory Evaluation
		Somatostatinomas
			Etiology/Pathophysiology
			Epidemiology
			Clinical Evaluation
			Laboratory Evaluation
		VIPoma
			Etiology/Pathophysiology
			Epidemiology
			Clinical Evaluation
			Laboratory Evaluation
		Imaging Evaluation
		Conclusion
		References
Part II: Selective Venous Sampling
	Chapter 6: Adrenal Vein Sampling
		Introduction
			Primary Aldosteronism
			Diagnosis of Primary Aldosteronism
			Imaging of Primary Aldosteronism
			Adrenal Vein Sampling
		Anatomy
			Embryology
			Right Adrenal Vein
			Left Arenal Vein
		AVS Procedure
			Preparation of Patients
			ACTH Stimulation
			Technique
			Venography of RAV
			Rapid Cortisol Assay
			Sequential vs. Simultaneous AVS
			C-Arm Cone-Beam CT
			Interpretation of AVS
		Complications
		Conclusion
		References
	Chapter 7: Selective Venous Sampling for Hyperparathyroidism
		Introduction
		Indications
		Techniques
			Anatomy
			Approaches
			Technical Considerations
		Interpretation
		Complications
		Outcomes
		Conclusion
		References
	Chapter 8: Ovarian Venous Sampling for Hyperandrogenism
		Introduction
			Diagnosis of Hyperandrogenism
			Imaging Evaluation
		Indications
		Contraindications
		Technique
			Anatomy
			Procedure Technique
		Challenges
		Results Interpretation
		Complications
		Conclusions
		References
	Chapter 9: Selective Venous Sampling for Hypercortisolism
		Introduction
		Indications
		Contraindications
		Technique
			Anatomy
			Anatomical Variations
			Pathophysiology
			Approach
			Technical Considerations
		Interpretation of Results
		Complications
		Conclusion
		References
	Chapter 10: Arterial Stimulation Venous Sampling for Pancreatic Endocrine Tumors
		Introduction
		Indications
			Insulinomas
			Gastrinomas
			Nesidioblastosis
			Other Indications
		Contraindications
		Technique
			Anatomy
			Procedure Technique
		Outcomes
		Complications
		Conclusions
		References
Part III: Medical Treatment of Endocrine Disorders
	Chapter 11: Medical Treatment of Hypersecretory Endocrine Disorders
		Hyperaldosteronism
			Surgical/Pharmacological Therapy
			Nuclear Medicine
		Hyperparathyroidism
			Primary Hyperparathyroidism: Surgical/Pharmacological Therapy
			Secondary Hyperparathyroidism: Surgical/Pharmacological Therapy
			Tertiary Hyperparathyroidism: Surgical/Pharmacological Therapy
			Nuclear Medicine
		Hyperandrogenism
			Pharmacological Therapy
			Nuclear Medicine
		Pancreatic Endocrine Tumors
			Surgical/Pharmacological Therapy
			Nuclear Medicine
		Hypercortisolism
			Surgical/Pharmacological Therapy
			Nuclear Medicine
		References
Part IV: Surgical Treatment of Endocrine Disorders
	Chapter 12: Surgical Treatment of Primary Aldosteronism
		Introduction
		Preoperative Optimization
		Goal of Surgery: Biochemical and Clinical Remission
		Adrenalectomy
			History of Adrenalectomy
			Surgical Approach
				Open Adrenalectomy
				Laparoscopic Adrenalectomy
					Transperitoneal (Transabdominal) Adrenalectomy
					Transabdominal Approach to the Right Adrenal Gland
					Transabdominal Approach to the Left Adrenal Gland
				Retroperitoneal Adrenalectomy
				Robotic Adrenalectomy
				Partial Adrenalectomy
		Complications
		Postoperative Care
		References
	Chapter 13: Surgical Management of Primary Hyperparathyroidism
		Preoperative Planning
			Imaging
				Ultrasound Evaluation
				Nuclear Medicine Imaging Techniques
				Dynamic Computed Tomography
			Fine Needle Aspiration with PTH Wash
			Preoperative Medical Optimization
		Indications
		Contraindications
		Surgical Interventions
			Bilateral Cervical Exploration
			Minimally Invasive Techniques
			Autotransplantation
			Intraoperative PTH Monitoring and Localization
		Complications
		Postoperative Care
		References
	Chapter 14: Surgical Management of Hypercortisolism from ACTH-Secreting Pituitary Adenomas
		Introduction
		Diagnosis and Preoperative Planning
		Indications and Contraindications
		Surgical Technique
			Approach
			Tumor Resection
			Skull Base/Sellar Repair
		Surgical Challenges
		Postoperative Care
		Surgical Complications, Unsuccessful Surgical Resection, and Non-remission
		Conclusion
		References
	Chapter 15: Surgical Treatment of Pancreatic Islet Cell Tumors
		Introduction
		Diagnosis and Surgical Evaluation
			Rationale for Surgery
			WHO 2017 Histological Classification
			Functional PNET
				Insulinoma
				Gastrinoma
				Glucagonoma
				VIPoma
				Somatostatinoma
			Nonfunctional PNET
			Hereditary Syndromes
				MEN-1
				Von Hippel-Lindau Syndrome
			Preoperative Workup
		Operative Approaches
			Curative Intent
			Pancreatic Resections
				Pancreaticoduodenectomy
				Distal Pancreatectomy
				Total Pancreatectomy
				Enucleation
				Transduodenal Approach
				Nonlocalized Lesions
			Contraindications and the Management of Advanced and Inoperable Disease
				Surgery for Advanced Disease
				Debulking and Palliative Resections
			Other Operative Considerations
				Cholecystectomy
				Perioperative Somatostatin Analogues
		Postoperative Care and Complications after Pancreatic Resections
			Postoperative Care
			Postoperative Complications
				Pancreatic Fistula
				Pancreatic Insufficiency
		Conclusion
		References
Part V: Interventional Treatment of Endocrine Disorders
	Chapter 16: Interventional Treatment of Primary Aldosteronism
		Introduction
		Adrenal Vein Sampling
		Ablation
			Patient Preparation
			Procedure
			Follow-Up
			Outcomes
		Embolization
			Patient Preparation
			Procedure
			Follow-Up
			Outcomes
		Conclusion
		References
	Chapter 17: Interventional Treatment of Hyperparathyroidism
		History of Interventional Treatment of Hyperparathyroidism
		Percutaneous Thermal Ablation of Parathyroid Glands
			Preprocedural Evaluation
			Indications and Contraindications
				Indications for PHPT Thermal Ablation
				Indications for SHPT Thermal Ablation
				Contraindications:
			Preparation Before Thermal Ablation
				Equipment Preparation
				Preparation of Medication and Needles
				Patient Preparation
			Thermal Ablation Procedure
				Patient Position
				Ultrasound Evaluation Before Ablation
				Local Anesthesia
				Liquid Isolation
				Thermal Ablation
				Real-Time Evaluation of Ablation Effect
			Complications and Prevention Strategies
		Percutaneous Parathyroid Injection
			Indications and Contraindications [29]
				Indications
				Contraindications
			Preparation Before Treatment
			Procedure
			Treatment Strategy
		References
	Chapter 18: Interventional Treatment of Thyroid Nodules
		Current Practice on Thyroid Nodules
			Workups
				Serum Thyroid Stimulation Hormone (TSH)
				Thyroid Sonography
				Bethesda System
			Treatment
				Benign Lesion
				Malignant Lesion
		Thyroid Radiofrequency Ablation
			Indications
				Indications
				Contraindications
			Anatomy
				The Thyroid Gland
				Vessels
				Muscles
				Nerves
			Procedure
				Preprocedural Workup
				The Procedure
				Postprocedural Care and Follow-Up
			Results
				Nonfunctioning Thyroid Nodules
				Autonomously Functioning Thyroid Nodules
				Marginal Regrowth
			Complications
				Pain
				Voice Change
				Hemorrhage
				Hypothyroidism
				Rupture
				Tracheal Injury
				Esophageal Injury
				Nausea and Vomiting
				Edema and Fever
		References
	Chapter 19: Arterial Embolization for Thyroid Goiter, Graves’ Disease, and Thyroid Malignancy
		Introduction
		Practical Anatomic Considerations for Thyroid Embolization
			Anatomic Determinants of Non-target Embolization to the Brain
			Anatomic Determinants of Non-target Embolization to the Spinal Cord
			Anatomic Determinants of Non-target Embolization to the Larynx, Face, Tongue, Skin, and Muscles
			Anatomic Determinants of Non-target Embolization to the Parathyroid Glands
			Anatomic Determinants of Non-target Embolization to the Trachea and Esophagus
			Anatomic Determinants of Non-target Embolization to the Hand
		Technical Fundamentals and Equipment Considerations
		Clinical Considerations for Thyroid Embolization
			Goiter Embolization
				Embolization as an Alternative to Radioiodide Therapy
				Thyroid Embolization in Treatment of Graves’ Disease
				Thyroid Embolization and Thyroid Storm
			Antineoplastic Drug Delivery to the Thyroid
		Summary
		References
	Chapter 20: Interventional Treatment of Hepatic Endocrine Tumors
		Introduction
		Patient Selection for Interventional Treatment
		Transarterial Embolization (TAE or “Bland” Embolization)
			Basic Principles
			Technique
			Selection of Embolic Agents
				Gelatin Sponge
				Polyvinyl Alcohol Particles (PVA)
				Microspheres
				n-Butyl Cyanoacrylate
		Transarterial Chemoembolization (TACE)
			Conventional TACE
			Drug-Eluting Beads TACE
		Additional Considerations in Embolic Therapy
			Tolerance and Complications
			Outcomes
			TAE vs. TACE
		Selective Internal Radiation Therapy (SIRT)
			Technique
			Outcomes
			Complications and Limitations
		Percutaneous Ablation
		Summary
		References
	Chapter 21: Special Considerations in Children: Pediatric Renal Vein Sampling
		Introduction
		Pediatric Hypertension
			Pathophysiology
		Pediatric Fibromuscular Dysplasia
			Diagnosis of Fibromuscular Dysplasia
		Pediatric Renal Vein Sampling
			Preprocedural Preparation
			Procedure Technique
		Summary
		References
Index