In:
European Journal of Endocrinology, Oxford University Press (OUP), Vol. 183, No. 6 ( 2020-12), p. 539-550
Abstract:
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 11 C-metomidate ( 11 C-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 11 C-MTO-PET without dexamethasone pretreatment in random order. The lateralization of 11 C-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 11 C-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and 11 C-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 11 C-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 11 C-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 11 C-MTO-PET with AVS was clinically suboptimal, and did not outperform adrenal CT. In a subgroup with CYP11B2-positive adenoma, 11 C-MTO-PET identified 53% of cases. 11 C-MTO-PET appeared to be inferior to AVS for subtype classification of PA.
Type of Medium:
Online Resource
ISSN:
0804-4643
,
1479-683X
Language:
Unknown
Publisher:
Oxford University Press (OUP)
Publication Date:
2020
detail.hit.zdb_id:
1485160-X
