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ABSTRACT: Objective
Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA.Design
We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery.Methods
Subjects underwent AVS and 11C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11C-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2.Results
In the whole study population, the concordance of AVS and 11C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11C-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum standardized uptake value ratio of 1.16 in 11C-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, AVS and 11C-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma.Conclusions
The concordance of 11C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11C-MTO-PET identified 53% of cases. 11C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.
SUBMITTER: Soinio M
PROVIDER: S-EPMC8045447 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
Soinio Minna M Luukkonen Anna-Kaarina AK Seppänen Marko M Kemppainen Jukka J Seppänen Janne J Pienimäki Juha-Pekka JP Leijon Helena H Vesterinen Tiina T Arola Johanna J Lantto Eila E Helin Semi S Tikkanen Ilkka I Metso Saara S Mirtti Tuomas T Heiskanen Ilkka I Norvio Leena L Tiikkainen Mirja M Tikkanen Tuula T Sane Timo T Välimäki Matti M Gomez-Sanchez Celso E CE Pörsti Ilkka I Nuutila Pirjo P Nevalainen Pasi I PI Matikainen Niina N
European journal of endocrinology 20201201 6
<h4>Objective</h4>Endocrine Society guidelines recommend adrenal venous sampling (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imaging of adrenal cortex with 11C-metomidate (11C-MTO) could offer a noninvasive alternative to AVS in the subtype classification of PA.<h4>Design</h4>We prospectively recruited 58 patients with confirmed PA who were eligible for adrenal surgery.<h4>Methods</h4>Subjects underwent AVS and 11C-MTO-PET without dexamethason ...[more]