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- •Preface
- •Contents
- •Contributors
- •References
- •Introduction
- •History
- •Prevalence
- •Interfering Medications
- •Lab Interpretation
- •Radiological Diagnosis
- •Introduction
- •Etiology
- •Epidemiology
- •Parathyroid Gland Anatomy
- •Clinical Evaluation
- •Historical Presentations
- •Normocalcemic Primary Hyperparathyroidism
- •Laboratory Evaluation
- •Initial Laboratory Testing
- •Calcium
- •Corrected Calcium
- •Ionized Calcium
- •Parathyroid Hormone Assays
- •First Generation Assays
- •Serum Phosphate
- •25-Hydroxyvitamin D (Vitamin D)
- •24-Hour Urine Calcium
- •Biochemical Stone Risk Analysis
- •1,25-Dihydroxy Vitamin D (Calcitriol)
- •Secondary Hyperparathyroidism
- •Medication Effects
- •Tertiary Hyperparathyroidism
- •Familial Hypocalciuric Hypercalcemia
- •Autoimmune Hypocalciuric Hypercalcemia
- •Pseudohypoparathyroidism
- •Imaging Evaluation
- •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
- •Conclusions
- •References
- •Introduction
- •Etiology
- •Epidemiology
- •Pathophysiology
- •Androgen Production by Endocrine Glands
- •Clinical Evaluation
- •Laboratory Evaluation
- •Imaging Evaluation
- •Conclusion
- •References
- •Introduction
- •Etiology
- •Epidemiology
- •Pathophysiology
- •Pituitary Corticotroph Adenomas: Cushing’s Disease
- •Ectopic ACTH Syndrome
- •Unilateral Adrenal Adenoma
- •Adrenocortical Carcinoma
- •Bilateral Adrenal Nodular Disease
- •Clinical Evaluation
- •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
- •Imaging Evaluation
- •ACTH-Secreting Pituitary Adenomas
- •Ectopic ACTH Syndrome
- •ACTH-Independent Hypercortisolism
- •References
- •Introduction
- •Etiology/Physiology
- •Epidemiology
- •Insulinoma
- •Etiology/Pathophysiology
- •Epidemiology
- •Clinical Evaluation
- •Laboratory Evaluation
- •Gastrinoma
- •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
- •Epidemiology
- •Clinical Evaluation
- •Laboratory Evaluation
- •Glucagonomas
- •Etiology/Pathophysiology
- •Introduction
- •Primary Aldosteronism
- •Adrenal Vein Sampling
- •Anatomy
- •Embryology
- •Right Adrenal Vein
- •Left Arenal Vein
- •AVS Procedure
- •ACTH Stimulation
- •Technique
- •Rapid Cortisol Assay
- •Sequential vs. Simultaneous AVS
- •C-Arm Cone-Beam CT
- •Complications
- •Conclusion
- •References
- •Introduction
- •Indications
- •Techniques
- •Anatomy
- •Approaches
- •Technical Considerations
- •Interpretation
- •Complications
- •Outcomes
- •Conclusion
- •References
- •Introduction
- •Imaging Evaluation
- •Indications
- •Contraindications
- •Technique
- •Anatomy
- •Procedure Technique
- •Challenges
- •Results Interpretation
- •Complications
- •Conclusions
- •References
- •Introduction
- •Indications
- •Contraindications
- •Technique
- •Anatomy
- •Anatomical Variations
- •Pathophysiology
- •Approach
- •Technical Considerations
- •Complications
- •Conclusion
- •References
- •Introduction
- •Indications
- •Insulinomas
- •Gastrinomas
- •Nesidioblastosis
- •Other Indications
- •Contraindications
- •Technique
- •Anatomy
- •Procedure Technique
- •Outcomes
- •Complications
- •Conclusions
- •References
- •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
- •Introduction
- •Preoperative Optimization
- •Adrenalectomy
- •Surgical Approach
- •Open Adrenalectomy
- •Laparoscopic Adrenalectomy
- •Transperitoneal (Transabdominal) Adrenalectomy
- •Retroperitoneal Adrenalectomy
- •Robotic Adrenalectomy
- •Partial Adrenalectomy
- •Complications
- •Postoperative Care
- •References
- •Preoperative Planning
- •Imaging
- •Ultrasound Evaluation
- •Nuclear Medicine Imaging Techniques
- •Dynamic Computed Tomography
- •Preoperative Medical Optimization
- •Indications
- •Contraindications
- •Surgical Interventions
- •Bilateral Cervical Exploration
- •Minimally Invasive Techniques
- •Autotransplantation
- •Complications
- •Postoperative Care
- •References
- •Introduction
- •Surgical Technique
- •Approach
- •Tumor Resection
- •Skull Base/Sellar Repair
- •Surgical Challenges
- •Postoperative Care
- •Conclusion
- •References
- •Introduction
- •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
- •Other Operative Considerations
- •Cholecystectomy
- •Perioperative Somatostatin Analogues
- •Postoperative Care
- •Postoperative Complications
- •Pancreatic Fistula
- •Conclusion
- •References
- •Introduction
- •Adrenal Vein Sampling
- •Ablation
- •Patient Preparation
- •Procedure
- •Follow-Up
- •Outcomes
- •Embolization
- •Patient Preparation
- •Procedure
- •Follow-Up
- •Outcomes
- •Conclusion
- •References
- •Preprocedural Evaluation
- •Contraindications:
- •Preparation Before Thermal Ablation
- •Equipment Preparation
- •Patient Preparation
- •Thermal Ablation Procedure
- •Patient Position
- •Ultrasound Evaluation Before Ablation
- •Local Anesthesia
- •Liquid Isolation
- •Thermal Ablation
- •Percutaneous Parathyroid Injection
- •Indications
- •Contraindications
- •Preparation Before Treatment
- •Procedure
- •Treatment Strategy
- •References
- •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
- •Results
- •Nonfunctioning Thyroid Nodules
- •Autonomously Functioning Thyroid Nodules
- •Marginal Regrowth
- •Complications
- •Pain
- •Voice Change
- •Hemorrhage
- •Hypothyroidism
- •Rupture
- •Tracheal Injury
- •Esophageal Injury
- •References
- •Introduction
- •Goiter Embolization
- •Summary
- •References
- •Introduction
- •Transarterial Embolization (TAE or “Bland” Embolization)
- •Basic Principles
- •Technique
- •Gelatin Sponge
- •Polyvinyl Alcohol Particles (PVA)
- •Microspheres
- •n-Butyl Cyanoacrylate
- •Transarterial Chemoembolization (TACE)
- •Conventional TACE
- •Drug-Eluting Beads TACE
- •Outcomes
- •TAE vs. TACE
- •Selective Internal Radiation Therapy (SIRT)
- •Technique
- •Outcomes
- •Percutaneous Ablation
- •Summary
- •References
- •Introduction
- •Pediatric Hypertension
- •Pathophysiology
- •Pediatric Fibromuscular Dysplasia
- •Pediatric Renal Vein Sampling
- •Preprocedural Preparation
- •Procedure Technique
- •Summary
- •References
- •Index

Diagnosis and Management
of Endocrine Disorders in
Interventional Radiology
Hyeon Yu
Charles T. Burke
Clayton W. Commander
123

Diagnosis and Management of Endocrine Disorders
in Interventional Radiology

Hyeon Yu • Charles T. Burke
Clayton W. Commander
Editors
Diagnosis and Management
of Endocrine Disorders in
Interventional Radiology

Editors
Hyeon Yu
Division of Vascular and Interventional
Radiology
Department of Radiology
University of North Carolina at Chapel Hill
School of Medicine
Chapel Hill, NC
USA
Clayton W. Commander
Division of Vascular and Interventional
Radiology
Department of Radiology
University of North Carolina at Chapel Hill
School of Medicine
Chapel Hill, NC
USA
Charles T. Burke
Division of Vascular and Interventional
Radiology
Department of Radiology
University of North Carolina at Chapel Hill
School of Medicine
Chapel Hill, NC
USA
ISBN 978-3-030-87188-8 ISBN 978-3-030-87189-5 (eBook)
https://doi.org/10.1007/978-3-030-87189-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface
Diseases of the endocrine system involve an imbalance in the natural homeostasis
of the hormones produced by the glands in the body. There are a variety of endocrine conditions characterized by either hormonal hyposecretion or hypersecretion.
Often, these conditions can lead to debilitating or, in some instances, life- threatening
situations that can be challenging to diagnose and treat. While one doesn’t often
consider interventional radiology a critical part of the endocrine clinic setting, there
are several conditions for which interventional radiologists can play a valuable role.
These disorders include primary aldosteronism, primary hyperparathyroidism,
Cushing’s disease, hormone-secreting pancreatic adenomas, and androgen- secreting
ovarian tumors. A collaboration of multiple specialties, including endocrinologists,
surgeons, and radiologists, is often needed to diagnose and manage these conditions.
Radiologists play a prominent role in the evaluation of patients with suspected
endocrine disorders. CT and MRI are commonly used rst-line imaging modalities;
however, cross-sectional imaging lacks physiologic information resulting in poor
specicity of these tests for many endocrine conditions. Thus, percutaneous selective venous sampling is a useful diagnostic tool for the medical and surgical management of patients with select endocrine disorders. Selective venous sampling is a
minimally invasive interventional procedure performed by interventional radiologists to localize sites of abnormal hormone secretion. These tests can conrm a
suspected clinical diagnosis and, in some instances, direct curative surgical therapy.
As venous sampling procedures are increasingly performed worldwide, the collaboration between interventional radiology, endocrinology, surgical endocrinology, surgical oncology, neurosurgery, and gynecology teams is essential. Currently,
there are limited guidelines from The Endocrine Society and relatively few published papers for each venous sampling procedure. Furthermore, except for the book
“PercutaneousVenousBlood Samplingin Endocrine Diseases” published in 1992
by Springer, there is no modern comprehensive guide for all traditional and newly
emerging selective venous sampling procedures.
To correct this information gap, we have put together a book focusing on selective venous sampling, including the interventional techniques for diagnosis and
chapters on the pathophysiology, epidemiology, clinical diagnosis, and medical,
v

vi
Preface
surgical, and interventional treatments of endocrine disorders. We have recruited
experts from endocrinology, endocrine surgery, radiology, and interventional radiology to provide a comprehensive and state-of-the-art textbook surrounding the diseases in which venous sampling is typically used. We have also included chapters
on the latest percutaneous therapies that may be the future for treating some common endocrine disorders, such as hyperthyroidism and hyperparathyroidism. And
given the rise in pediatric interventional radiology in recent years, we felt it was
important to dedicate a chapter to venous sampling in this patient population.
This book is organized into ve parts: Clinical, Laboratory, and Radiological
Diagnosis, Selective Venous Sampling, Medical and Surgical Management, and
Intervention Treatments, with chapters in each part addressing primary aldosteronism, hyperparathyroidism, hyperandrogenism, hypercortisolism, and pancreatic
islet cell tumors. This type of organization allows the reader to read the book straight
through to get a comprehensive overview from the initial evaluation through the
different management options for these disease processes. Alternatively, the reader
can select specic chapters to answer a particular question or focus on a single disease process.
As interventional radiologists, we have experienced rsthand the value and complexity that venous sampling procedures can provide. These procedures can be
gratifying and signicantly improve patient care. Understanding the relevant disease processes from the perspective of the other members of the multi-disciplinary
teams and learning the selective venous sampling techniques from the experts will
help guide the interventional radiologist to be a more valuable team member. We
have thoroughly enjoyed the process of bringing this book together, and we hope
that all readers who are involved in the management of these patients will nd this
book a valuable reference for many years.
Chapel Hill, NC, USA HyeonYu
Chapel Hill, NC, USA CharlesT.Burke
Chapel Hill, NC, USA ClaytonW.Commander

Contents
Part I Clinical, Laboratory, and Radiological
Diagnosis of Endocrine Disorders
1 Clinical, Laboratory, and Radiological
Diagnosis of Primary Aldosteronism . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ali Qamar and Lauren M. B. Burke
2 Clinical, Laboratory, and Radiological Diagnosis of
Hyperparathyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Jennifer D. Merrill, Carlos A. Zamora, and Jorge D. Oldan
3 Clinical, Laboratory, and Radiological Diagnosis of
Hyperandrogenism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Diana Soliman, Ali Qamar, and Lauren M. B. Burke
4 Clinical, Laboratory, and Radiological Diagnosis of
Hypercortisolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Paul A. Guido and Carlos A. Zamora
5 Clinical, Laboratory, and Radiological Diagnosis of
Pancreatic Islet Cell Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Jashalynn German, Lauren M. B. Burke, and Jennifer V. Rowell
Part II Selective Venous Sampling
6 Adrenal Vein Sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Hyeon Yu and Clayton W. Commander
7 Selective Venous Sampling for Hyperparathyroidism . . . . . . . . . . . . . 111
Takayuki Yamada and Akiyuki Kotoku
vii

viii
Contents
8 Ovarian Venous Sampling for Hyperandrogenism . . . . . . . . . . . . . . . 125
Clayton W. Commander
9 Selective Venous Sampling for Hypercortisolism . . . . . . . . . . . . . . . . . 137
James P. Ho and Sten Y. Solander
10 Arterial Stimulation Venous Sampling for
Pancreatic Endocrine Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Charles T. Burke
Part III Medical Treatment of Endocrine Disorders
11 Medical Treatment of Hypersecretory Endocrine Disorders . . . . . . . 161
Diana Soliman, Ali Qamar, and Jorge D. Oldan
Part IV Surgical Treatment of Endocrine Disorders
12 Surgical Treatment of Primary Aldosteronism . . . . . . . . . . . . . . . . . . 171
Lawrence Kim and Juan Camilo Mira
13 Surgical Management of Primary Hyperparathyroidism . . . . . . . . . . 187
Megan Elizabeth Lombardi and Jen Jen Yeh
14 Surgical Management of Hypercortisolism
from ACTH-Secreting Pituitary Adenomas . . . . . . . . . . . . . . . . . . . . . 199
Justin C. Morse, Brian D. Thorp, and Adam J. Kimple
15 Surgical Treatment of Pancreatic Islet Cell Tumors . . . . . . . . . . . . . . 211
Joseph Kearney, Jeffrey Johnson, and Hong Jin Kim
Part V Interventional Treatment of Endocrine Disorders
16 Interventional Treatment of Primary Aldosteronism . . . . . . . . . . . . . 233
Christos Georgiades, Panagiotis Liasides, and Kelvin Hong
17 Interventional Treatment of Hyperparathyroidism . . . . . . . . . . . . . . . 243
Chengzhong Peng and Qian Yang
18 Interventional Treatment of Thyroid Nodules . . . . . . . . . . . . . . . . . . . 259
Auh Whan Park, Tim Huber, and Jung Hwan Baek
19 Arterial Embolization for Thyroid Goiter, Graves’
Disease, and Thyroid Malignancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Alan Alper Sag, Jessica L. Dahle, Jennifer M. Perkins,
Hadiza S. Kazaure, Anne Weaver, Sona Sharma,
Michael T. Stang, Daniel J. Rocke, Jennifer H. Choe,
Tony P. Smith, and Randall P. Scheri

Contents
20 Interventional Treatment of Hepatic Endocrine Tumors . . . . . . . . . . 315
Kurt Zacharias and Osman Ahmed
21 Special Considerations in Children: Pediatric Renal
Vein Sampling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Kent A. Cabatingan
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
ix

Contributors
Osman Ahmed Department of Interventional Radiology, University of Chicago
Medical Center, Chicago, IL, USA
JungHwanBaek Department of Radiology and Research Institute of Radiology,
University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
CharlesT.Burke Division of Vascular and Interventional Radiology, Department
of Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC, USA
LaurenM.B.Burke Department of Radiology, Division of Abdominal Imaging,
University of North Carolina School of Medicine, Chapel Hill, NC, USA
Kent A. Cabatingan Interventional Radiology, Children’s Minnesota,
Minneapolis, MN, USA
JenniferH.Choe Division of Hematology and Medical Oncology, Department of
Medicine, Duke University Medical Center, Durham, NC, USA
Clayton W. Commander
Department of Radiology, University of North Carolina at Chapel Hill School of
Medicine, Chapel Hill, NC, USA
Jessica L. Dahle Endocrine Surgery, Department of Surgery, Ochsner
Health, LA, USA
ChristosGeorgiades Department of Radiology & Radiological Sciences, Johns
Hopkins University, Baltimore, MD, USA
Jashalynn German Department of Medicine, Division of Endocrinology,
Metabolism and Nutrition, Duke University, Durham, NC, USA
Paul A. Guido Department of Endocrinology, University of North Carolina,
Chapel Hill, NC, USA
Division of Vascular and Interventional Radiology,
xi
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