Skip to main content
SpringerLink
Log in

11C-metomidate positron emission tomography after dexamethasone suppression for detection of small adrenocortical adenomas in primary aldosteronism

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether dexamethasone suppression treatment can improve 11 C-metomidate positron emission tomography (MTO-PET) detection of small adrenocortical adenomas in primary aldosteronism (PA).

Materials and methods

Eleven patients with proven PA and two patients with non-hyperfunctioning adrenocortical incidentalomas and small adrenocortical tumours observed on CT underwent MTO-PET before and 3 days after administration of oral dexamethasone suppression treatment. Small “hot-spot” regions of interest comprising 4 pixels (SUVhs) and 1 pixel (SUVmax) were placed in the tumour area with the highest radioactivity concentration and their respective standardised uptake values (SUV) were recorded.

Results

All tumours were detected and categorised as adrenocortical by MTO-PET. SUVhs as well as SUVmax were higher in PA compared to nonfunctional adenomas. Normal adrenal cortex was suppressed after dexamethasone (p < 0.05), but tumour SUV was not significantly decreased after suppression in either PA or nonfunctional tumours (p > 0.05). However, these changes caused no significant increase in the tumour-to-normal adrenal ratio (p > 0.05).

Conclusion

MTO-PET is a highly sensitive method for detecting and categorising even small adrenocortical tumours in PA. In this series, dexamethasone-suppressed MTO-PET was unable to increase the tumour-to-normal adrenal ratio to further facilitate detection of small adenomas in PA as an alternative to adrenal venous sampling.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM (2003) High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non selective’ screening of hypertensive patients. J Hypertens 21:2149–2157

    Article  CAS  PubMed  Google Scholar 

  2. Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young WF Jr (2004) Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 89:1045–1050

    Article  CAS  PubMed  Google Scholar 

  3. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF Jr (2008) Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93(9):3266–3281

    Article  CAS  PubMed  Google Scholar 

  4. Mattsson C, Young WF Jr (2006) Primary aldosteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol 2:198–208

    Article  CAS  PubMed  Google Scholar 

  5. Letavernier E, Peyrard S, Amar L, Zinzindohoué F, Fiquet B, Plouin PF (2008) Blood pressure outcome of adrenalectomy in patients with hyperaldosteronism with or without unilaterlal adenoma. J Hypertens 26:1816–1823

    Article  CAS  PubMed  Google Scholar 

  6. Walz MK, Gwosdz R, Levin SL, Alesina PF, Suttorp AC (2008) Metz KA et al Retroperitoneoscopic adrenalectomy in Conn´s syndrome caused by adrenal adenoma or nodular hyperplasia. World J Surg 32(5):847–853

    Article  PubMed  Google Scholar 

  7. Enberg U, Volpe C, Höög A, Wedell A, Farnebo LO, Thorén M (2004) Hamberger B Postoperative differentiation between unilateral adenoma and bilateral adrenal hyperplasia in primary aldosteronism by mRNA expression of gene CYP11B2. Eur J Endocrinol 151(1):73–85

    Article  CAS  PubMed  Google Scholar 

  8. Pang TC, Bambach C, Monhagan JC, Siduh S, Bune A, Delbridge L, Sywak M (2007) Outcomes of laparoscopic adrenalectomy for hyperaldosteronism. ANZ J Surg 77(9):768–773

    Article  PubMed  Google Scholar 

  9. Gockel I, Heintz A, Polta M, Juninger T (2007) Long-term results of endoscopic adrenalectomy for Conn´s syndrome. Am Surg 73(2):174–180

    PubMed  Google Scholar 

  10. Catena C, Coloussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna L, Sechi LA (2008) Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 14;168(1):80-85

    Google Scholar 

  11. White ML, Gauger PG, Doherty GM, Cho KJ, Thompson NW, Hammer GD, Miller BS (2008) The role of radiologic studies in the evaluation and management of primary hyperaldosteronism. Surgery 144(6):926–933

    Article  PubMed  Google Scholar 

  12. Lombardi CP, Rafaelli M, De Crea C, Rufini V, Treglia G, Bellantone R (2007) Noninvasive adrenal imaging in hyperaldosteronism: is it accurate for correctly identifying patients who should be selected for surgery? Langenbecks Arch Surg 392(5):623–628

    Article  PubMed  Google Scholar 

  13. Zarnegar R, Bloom AI, Lee J, Kerlan RK Jr, Wilson MW, Laberge JM et al (2008) Is adrenal venous sampling necessary in all patients with hyperaldosteronism before adrenalectomy? J Vasc Interv Radiol 19(1):66–71

    Article  PubMed  Google Scholar 

  14. Bergström M, Juhlin C, Bonasera TA, Sundin A, Rastad J, Akerstrom G, Långström B (2000) PET imaging of adrenal cortical tumours with the 11ß-hydroxylase tracer 11C-metomidate. J Nucl Med 41:275–282

    PubMed  Google Scholar 

  15. Hennings J, Lindhe Ö, Bergström M, Långström B, Sundin A, Hellman P (2006) [11C]-Metomidate positron emission tomography of adrenocortical tumours in correlation with histopathological findings. J Clin Endocrinol Metab 91:1410–1414

    Article  CAS  PubMed  Google Scholar 

  16. Zettinig G, Mitterhauser M, Wadsak W, Becherer A, Pirich C, Vierhapper H, Niederle B, Dudczak R, Kletter K (2004) Positron emission tomography imaging of adrenal masses: 18F-fluorodeoxyglucose and the 11ß-hydroxylase tracer 11C-metomidate. Eur J Nucl Med Mol Imaging 31:403–410

    Article  Google Scholar 

  17. Minn H, Salonen A, Friberg J, Roivainen A, Viljanen T, Långsjö J, Salmi J, Valimäki M, Nagren K, Nuutila P (2004) Imaging of adrenal incidentalomas with PET using 11C-metomidate and 18F-FDG. J Nucl Med 45:972–979

    CAS  PubMed  Google Scholar 

  18. Hennings J, Hellman P, Ahlström H, Sundin A (2009) Computed tomography, magnetic resonance imaging and 11C-metomidate positron emission tomography for evaluation of adrenal incidentalomas. Eur J Radiol 69(2):314–323

    Article  PubMed  Google Scholar 

  19. Gross MD, Shapiro B, Grekin RJ, Freitas JE, Glazer G, Beierwaltes WH, Thompson NW (1984) Scintigraphic location of adrenal lesions in primary aldosteronism. Am J Med 77:839–844

    Article  CAS  PubMed  Google Scholar 

  20. Gross MD, Shapiro B (1989) Scintigraphic studies in adrenal hypertension. Semin Nucl Med 19:122–143

    Article  CAS  PubMed  Google Scholar 

  21. Nocadie-Calzada M, Hulgo D, Lambert M, Ernst O, Proye C, Wemeau JL, Marchandise X (1999) Efficacy of iodine-131 6beta-methyl-iodo-19-norcholesterol scintigraphy and computed tomography in patients with primary aldosteronism. Eur J Nucl Med 26:1326–1332

    Google Scholar 

  22. Volpe C, Enberg U, Sjögren A, Wahrenberg H, Jacobsson H, Törring O, Hamberger B, Thorén M (2008) The role of adrenal scintigraphy in the preoperative management of primary aldosteronism. Scand J Surg 97:248–253

    CAS  PubMed  Google Scholar 

Download references

Conflicts of Interest

None.

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, Uppsala University, SE-751 85, Uppsala, Sweden

    J. Hennings & P. Hellman

  2. Research and Development Unit, Jämtland County Council, Ostersund, Sweden

    J. Hennings

  3. Department of Radiology, Karolinska University Hospital, Stockholm, Sweden

    A. Sundin

  4. Uppsala University Hospital, Uppsala, Sweden

    A. Sundin

  5. Department of Medical Sciences, Uppsala University, Uppsala, Sweden

    A. Hägg

Authors
  1. J. Hennings
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Sundin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Hägg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Hellman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Hennings.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hennings, J., Sundin, A., Hägg, A. et al. 11C-metomidate positron emission tomography after dexamethasone suppression for detection of small adrenocortical adenomas in primary aldosteronism. Langenbecks Arch Surg 395, 963–967 (2010). https://doi.org/10.1007/s00423-010-0681-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0681-7

Keywords

Search

Navigation