Table 3.

AVS Results of the Patients With Cortisol-Producing Adenoma and Comparison of Cortisol/Catecholamine Lateralization Ratio With Other Ratio From the Literature

Reference	Patient	Cortisol lateralization ratio	Cortisol/catecholamine lateralization ratio	Cortisol/aldosterone lateralization ratio	Cortisol/DHEAS lateralization ratio	Outcomes
Papakokkinou et al. [33]	1. Case 1	2.5 R to L ratio	3.6 Cortisol/noradrenaline, 4.2 Cortisol/adrenaline	2.6	1.5	Adrenal insufficiency after right unilateral adrenalectomy, adrenal adenoma, CT Bilateral adrenal incidentaloma (R 32 × 18, L 14 × 8 mm)
	2. Case 7	1.65 L to R ratio	12.5 Cortisol/noradrenaline, 330 Cortisol/adrenaline	7.1	1.6	Adrenal insufficiency after left unilateral adrenalectomy, adrenal adenoma, CT Bilateral adenomas (R 22 × 15, L 64 × 50 mm)
	3. Case 8	1.53 R to L ratio	2.6 Cortisol/noradrenaline, 2.1 Cortisol/adrenaline	1.1	1	Bilateral adrenalectomy, PBMAH with bilateral nodules, CT Bilaterally enlarged adrenal glands (R 50 × 47, L 41 × 32 mm)
	4. Case 9	1.99 R to L ratio	2.6 Cortisol/noradrenaline, 2.6 Cortisol/adrenaline	0.82	1.5	Bilateral adrenalectomy, PPNAD, with normal CT
	5. Case 10	1.28 L to R ratio	1.44 Cortisol/noradrenaline, 2.7 Cortisol/adrenaline	0.97	1.28	Bilateral adrenalectomy, PPNAD, with normal CT
Lee et al. [34]	6. Case 1	4.62 L to R ratio	5.18 Cortisol/epinephrine	4	NA	Right side adrenalectomy for PA and left side adrenalectomy for SCS, adrenal insufficiency after second left side adrenalectomy
Maghrabi et al. [18]	7. Case 1	0.86 L to R ratio 1.16 R to L ratio	2.1 L to R Cortisol/epinephrine 0.5 R to L Cortisol/epinephrine	NA	NA	Left adrenalectomy, AIMAH (left adrenal mass 3.1 × 2.5 cm, right adrenal nodule 1.2 × 1.9 cm) improvement of blood pressure, but no satisfactory effects on blood sugar and lipid profile

Listed in reverse order of the year of publication [18, 33, 34].

The cortisol/catecholamine ratio is sometimes a better method to detect the source of cortisol production (Number 1, 2, and 7). The cortisol/aldosterone ratio and cortisol/DHEAS ratio are less sensitive than cortisol/catecholamine ratio in lateralizing the source of cortisol production.

Abbreviations: AIMAH, adrenocorticotropin independent macronodular adrenocortical hyperplasia; ACTH, adrenocorticotropic hormone; AVS, adrenal venous sampling; DHEAS, dehydroepiandrosterone sulfate; L, left; NA, not available; PBMAH, primary bilateral macronodular adrenal hyperplasia; PPNAD, primary pigmented nodular adrenocortical disease; R, right.