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FDG PET/CT Scan and Functional Adrenal Tumors: A Pilot Study for Lateralization

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Abstract

Background

Patients with Cushing’s Syndrome (CS) and Conn’s Syndrome with bilateral adrenal masses pose a dilemma. Uptake of 18F-FDG by hyperfunctioning adrenal glands has not been previously reported and may help lateralize. The aim was to determine if 18F-FDG PET/CT scan could identify hyperfunctioning adrenal masses and determine a biological basis for uptake.

Methods

Patients with nonfunctional adenomas (n = 9), CS (n = 11), and Conn’s syndrome (n = 4) underwent an 18F-FDG PET/CT scan with a volume of interest circumscribing each mass to obtain a maximal standardized uptake value (SUVmax). Thirty-two adrenal masses were analyzed. Genome-wide expression data from an independent cohort were analyzed in nonfunctioning adenomas (n = 20), Conn’s syndrome (n = 29), and CS (n = 24) focusing on GLUT genes. For genes differentially expressed, immunohistochemistry was performed on tissue samples.

Results

Cortisol-secreting masses (n = 16) had a higher average SUVmax of 5.9 compared to nonfunctioning masses (n = 11, average SUVmax 4.2) and aldosterone-hypersecreting masses (n = 5, average SUVmax 3.2) (p = 0.007). SUVmax cut-off of 5.33 had 50.0 % sensitivity and 81.8 % specificity in localizing a cortisol-secreting mass. GLUT3 expression was 2.19-fold higher in patients with CS compared to patients with nonfunctioning adenomas (p = 0.003) and 2.16-fold higher in patients with CS compared to Conn’s syndrome (p = 0.006). GLUT3 immunohistochemistry showed 2.2-fold higher staining in CS tumor samples compared to nonfunctioning adenomas.

Conclusions

Differential 18F-FDG PET/CT uptake was observed in patients with nonfunctioning, aldosterone-hypersecreting, and cortisol-secreting masses. GLUT3 overexpression in cortisol-secreting tumor likely accounts for the differential uptake. Future larger cohort studies will need to be conducted to determine if 18F-FDG PET/CT uptake can lateralize cortisol-secreting adrenal masses in patients with bilateral adrenal masses.

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Financial support

This research was supported by the intramural research program of the Center for Cancer Research, National Cancer Institute, National Institutes of Health.

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Authors and Affiliations

  1. Endocrine Oncology Branch, Clinical Research Center, National Cancer Institute, NIH, Building 10-CRC, Room 3-5840, Bethesda, MD, 20892, USA

    Dhaval Patel, Sudheer Kumar Gara, Myriem Boufraqech, Naris Nilubol & Electron Kebebew

  2. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Ryan J. Ellis

  3. PET Department, Clinical Center, NIH, Bethesda, MD, 20892, USA

    Corina Millo

  4. Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, 20892, USA

    Constantine A. Stratakis

Authors
  1. Dhaval Patel
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  2. Sudheer Kumar Gara
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  3. Ryan J. Ellis
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  4. Myriem Boufraqech
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  5. Naris Nilubol
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  7. Constantine A. Stratakis
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  8. Electron Kebebew
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Correspondence to Electron Kebebew.

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Patel, D., Gara, S.K., Ellis, R.J. et al. FDG PET/CT Scan and Functional Adrenal Tumors: A Pilot Study for Lateralization. World J Surg 40, 683–689 (2016). https://doi.org/10.1007/s00268-015-3242-y

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  • DOI: https://doi.org/10.1007/s00268-015-3242-y

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