Feasibility of Iodine-131 6β-Methyl-Iodo-19 Norcholesterol (NP-59) Scintigraphy to Complement Adrenal Venous Sampling in Management of Primary Aldosteronism: A Case Series

Lee, Jeongmin; Ha, Jeonghoon; Lee, Sang-Kuon; Park, Hye Lim; Kim, Sung Hoon; Lim, Dong-Jun; Lee, Jung Min; Chang, Sang-Ah; Kang, Moo Il; Kim, Min-Hee

doi:10.2147/ijgm.s288774

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…Cases ‘detected’ by the algorithm tended to have larger adrenal masses, lower aldosterone levels and frequently suppressed ACTH levels. In our experience reported here, when such cases have been identified and subjected to surgery to remove the mass after positive NP59 imaging, 33 the postoperative biochemical features are much in keeping with a true cortisol producing mass—suppressed morning cortisol and eventual rise in ACTH levels with recovery.…”

Section: Discussionsupporting

confidence: 51%

Apparent failed and discordant adrenal vein sampling: A potential confounding role of cortisol cosecretion?

Kline

Campbell

et al. 2021

Clinical Endocrinology

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Objective Adrenal vein sampling (AVS) and computed tomography (CT) often show confusingly discordant lateralisation results in primary aldosteronism (PA). We tested a biochemical algorithm using AVS data to detect cortisol cosecretion as a potential explanation for discordant cases. Design Retrospective analysis from a large PA + AVS database. Patients All patients with PA and AVS, 2005–2020. Measurements An algorithm using biochemical data from paired AVS + CT images was devised from physiological first principles and informed by data from unilateral, AVS–CT concordant patients. The algorithm involved calculations based upon the expectation that low cortisol levels exist in adrenal vein effluent opposite an aldosterone‐and‐cortisol‐producing adrenal mass and may reverse lateralisation due to inflated aldosterone/cortisol ratios. Main Outcomes The algorithm was applied to cases with discordant CT–AVS lateralisation to determine whether this might be a common or explanatory finding. Clinical and biochemical characteristics of identified cases were collected via chart review and compared to CT–AVS concordant cases to detect evidence of biological plausibility for cortisol cosecretion. Results From a total of 588 AVS cases, 141 AVS + CT pairs were clear unilateral PA cases, used to develop the three‐step algorithm for AVS interpretation. Applied to 88 AVS + CT discordant pairs, the algorithm suggested possible cortisol cosecretion in 40%. Case review showed that the proposed cortisol cosecretors, as identified by the algorithm, had low/suppressed adrenocorticotropic hormone levels, larger average nodule size and lower plasma aldosterone. Conclusions Pending external validation and outcome verification by surgery and tissue immunohistochemistry, cortisol cosecretion from aldosteronomas may be a common explanation for discordant CT–AVS results in PA.

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Section: Discussionsupporting

confidence: 51%

Apparent failed and discordant adrenal vein sampling: A potential confounding role of cortisol cosecretion?

Kline

Campbell

et al. 2021

Clinical Endocrinology

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“…Although the gold standard lateralization procedure remains bilateral adrenal vein sampling (AVS), scintigraphy with I131-norcholesterol is preferred as it is a less invasive test [ 1 , 8 , 9 ]. This technique allows the assessment of adrenal function and can be used to differentiate between APA and IAH (unilateral adrenal uptake most likely indicates APA, and bilateral uptake suggests IAH).…”

Section: Discussionmentioning

confidence: 99%

Bilateral Adrenalectomy in a Patient With Refractory Primary Aldosteronism Due to Adrenal Hyperplasia

Marín-Martínez¹,

Ríos-Vergara²,

Kyriakos³

et al. 2022

Cureus

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Primary aldosteronism (PA) is a frequent cause of secondary hypertension. The main cause of PA is bilateral adrenal hyperplasia, and treatment is usually medical with mineralocorticoid receptor antagonists (MRAs) such as spironolactone or eplerenone. In this paper, we present a rare clinical case of a middle-aged female with refractory arterial hypertension and hypokalemia that complementary medical tests confirmed PA due to bilateral hyperplasia, and despite a maximum dose of spironolactone and oral potassium supplements, there was no clinical response. Because of this, finally, the patient needed surgical treatment based on bilateral adrenalectomy, which was effective. This is unusual and poorly described in the medical literature.

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“…С появлением ОФЭКТ/КТ в арсенале специалистов чувствительность визуализации альдостером резко возросла (81,8%) [94]. ОФЭКТ/КТ c NP-59 используется как альтернативный диагностический метод для верификации ПГА на ранней стадии заболевания, в том числе среди пациентов с атипичым и субклиническим течением (рис.1) [95][96], и может использоваться вместе с селективным венозным забором венозной крови (ССЗВК) или вместо ССЗВК в случае неинформативности или невозможности проведения последнего [94,97]. В таблице 1 отображены факторы, способные повлиять на захват NP-59.…”

Section: I-np-59 (метилнорхолестерол)unclassified

Personalized molecular visualization and radiotheranostics of adrenal tumors

Omelchuk¹,

Degtyarev²,

Rumiantsev³

2022

Med. vestn. Ûga Ross.

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Th e diagnosis of adrenal tumors has improved signifi cantly over the past decades thanks to laboratory research and anatomical imaging techniques. In some cases, these methods make it possible to distinguish a benign tumor from a malignant one, and in combination with invasive methods, the accuracy of such diagnostics varies from 80 to 100%. However, in cases of pheochromocytoma, this invasive intervention can induce a hypertensive crisis. Hybrid molecular imaging techniques such as single-photon emission tomography (SPECT) and positron emission tomography (PET), coupled with CT or MRI, have come to the rescue. Molecular imaging techniques are non-invasive and safe for patients, and the information obtained allows you to more accurately determine the optimal treatment tactics. Purpose: in our review, we will try to cover all modern and promising methods of molecular imaging of adrenal formations and radionuclide therapy, which constitute a new trend in the development of nuclear medicine in the world - radiotheranostics (radionuclide therapy based on radionuclide diagnostics). Methods: We conducted a systematic review of the literature obtained from the open databases Scopus and Pubmed describing the latest methods of radiotherapy of adrenal tumors. We then classifi ed the findings based on mechanism of action, point of application, and relevance of radioactive tracers, comparing their effectiveness and availability.

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Feasibility of Iodine-131 6β-Methyl-Iodo-19 Norcholesterol (NP-59) Scintigraphy to Complement Adrenal Venous Sampling in Management of Primary Aldosteronism: A Case Series

Cited by 5 publications

References 29 publications

Apparent failed and discordant adrenal vein sampling: A potential confounding role of cortisol cosecretion?

Apparent failed and discordant adrenal vein sampling: A potential confounding role of cortisol cosecretion?

Bilateral Adrenalectomy in a Patient With Refractory Primary Aldosteronism Due to Adrenal Hyperplasia

Personalized molecular visualization and radiotheranostics of adrenal tumors

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