19-iodocholesterol and 6-iodomethylcholesterol

Adrenal scintigraphy with 131I-6 beta-iodomethyl-19-noncholesterol requires well-prepared patients. Its interpretation requires trained observers with good knowledge of adrenal physiology and adrenal diseases. This multidisciplinary cooperative work was conducted by endocrinologists, nuclear medicine physicians and surgeons, in order to help physicians to optimize indications and practical implementation of this scintigraphy, which has constraints and pitfalls but is very informative.

Topics: 19-Iodocholesterol; Adrenal Glands; Humans; Iodine Radioisotopes; Radionuclide Imaging

The aim of the study was to investigate the accuracy of iodomethyl norcholesterol, a new adrenal isotopic scanning agent, in the strategy of aldosteronism localization. Among 1499 patients examined in the clinic in 1987, 49 presented with primary aldosteronism. Nine were explored by adrenal scintigraphy (SCI). Mean age was 50 +/- 10 ans, blood pressure was 188 +/- 26/110 +/- 17 mmHg. Initial serum kalemia was 3.2 +/- 0.4 mMol/l, urinary potassium 67 +/- 39 mMol/d; standing plasma active renin was 9.9 +/- 5.0 pg/ml (20 less than N less than 50), supine plasma aldosterone was 316 +/- 200 pg/ml (50 less than N less than 150) and aldosterone excretion rate was 49 +/- 27 microgr/day (N less than 17). Adrenal CT-scan correctly predicted unilateral adenoma in 7 patients (size from 5 to 15 mm). CT-scan was negative twice. Adrenal vein aldosterone sampling and phlebography confirmed adenoma in the 8th patient. 7 patients underwent surgery, with pathological confirmation of the diagnosis. The diagnosis of adrenal hyperplasia (AH) was made in the 9th patient. (table; see text) When compared to CT-scan, SCI is unuseful if a tumor (greater than or equal to 10 mm) is detected on CT-scan (2 SCI false-negative/5 CT-scan tumors). At the opposite, when CT-scan is negative, SCI localizes 2 tumors in 4 patients (2 adenomas).. SCI should not be used as first step diagnosis procedure in the localization of primary aldosteronism.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Gland Neoplasms; Adult; Cholesterol; Female; Humans; Hyperaldosteronism; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging

The aim of this study was three-fold: 1) to quantify [131I]-6beta-iodomethyl-norcholesterol ([131I]-NP-59) adrenal uptake trend in patients with incidentalomas, 2) to identify a specific uptake trend (TREND) capable of characterising pre-clinical Cushing syndrome (PC-CS) patients, 3) to assess the clinical availability of TREND as a prognostic factor of late clinical outcome in a cohort of patients with bilateral adrenal adenomas.. Fifty-seven consecutive patients were examined using three-head SPECT at 24, 48, 72 hours following intravenous injection of [131I ]-NP-59. On the basis of the absence or presence of hormonal abnormalities, the selected population was classified as GR1 or GR2, respectively. Adrenal glands were classified into 4 groups taking into account both the patient group (GR1, GR2) and the presence (+) or absence (-) of the adenoma (AD) on CT scan. Using ROI technique, adrenal-liver uptake ratio (A/L) was estimated bilaterally at 24, 48 and 72 hours. For each adrenal group, mean [131I]-NP-59 uptake trends were derived.. TREND was significantly different between GR1/AD+ and GR2/AD+. Among GR2/AD+ patients, TREND correctly identified PC-CS with a global accuracy of 74%. Two patients with bilateral incidentaloma developed an overt CS. In both patients, TREND correctly identified the hyperfunctioning adrenal, thus permitting an effective sparing adrenalectomy.. TREND seems to be a parameter which closely reflects adrenal physiological behaviour, especially in the case of bilateral adrenal involving. The possibility to quantify even contralateral adrenal uptake as standardised index provides additional useful information about normal adrenal parenchyma and, indirectly, about adenoma functional autonomy.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex Neoplasms; Cushing Syndrome; Female; Humans; Image Interpretation, Computer-Assisted; Male; Metabolic Clearance Rate; Middle Aged; Radiopharmaceuticals; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

The goal of this study was to evaluate the clinical reliability of the (131)I-6 beta-iodomethyl-norcholesterol ((131)I-NP-59) uptake semiquantitative evaluation method we propose for the characterization of adrenocortical masses in a selected population of patients with disease clinically classified as subclinical (SC) and preclinical (PC) Cushing's syndrome (CS) according to Reincke's definition.. Forty-seven consecutive patients with incidentally discovered unilateral adrenal masses were examined by a triple-head SPECT system after intravenous injection of (131)I-NP-59. Abdominal SPECT was performed at 24, 48, 72, and, in selected cases, 96 h after tracer injection. Connected with adrenals and liver, a standard elliptic region of interest (ROI) was manually drawn, taking care to avoid the gallbladder region. The adrenal ROI integral count, obtained by summing the 24-, 48-, and 72-h counting values, was normalized by the hepatic integral count. Subsequently, the adrenal percentage of relative uptake (UPT%) was computed.. Discriminant analysis was performed on the variables UPT%, adrenocorticotropic hormone (ACTH) serum concentration, and CT mass dimension (CTMD) to determine the variable, or combination thereof, best discriminating between the SC-CS and PC-CS groups. Compared with both ACTH and CTMD variables, univariate analysis confirmed the UPT% variable as the most significant to discriminate between these 2 clinical groups. In fact, UPT% alone correctly classified 8 of 9 patients in the SC-CS group and 20 of 22 patients in the PC-CS group with 95% positive and 80% negative predictive values and with overall accuracy, sensitivity, and specificity equal to 90%, 91%, and 89%, respectively. When all 3 variables were submitted to stepwise discriminant analysis, the derived classification matrix, after cross-validation, correctly classified 9 of 9 patients in the SC-CS group and 18 of 22 patients in the PC-CS group with 100% positive and 69% negative predictive values and with overall accuracy, sensitivity, and specificity equal to 87%, 82%, and 100%, respectively.. According to these initial results, use of the proposed semiquantitative approach associated with both laboratory screening for cortisol production and CTMD measure seems to be able to increase the clinical diagnostic accuracy of PC-CS. This approach could be used in the follow-up of adrenal mass function every time hormonal or clinical features are suggestive of adrenocortical hyperfunction.

Topics: 19-Iodocholesterol; Adrenal Cortex; Adrenal Gland Neoplasms; Adult; Aged; Cushing Syndrome; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon

In order to define the role of scintigraphy in determining the aetiology of primary aldosteronism, 41 patients were examined by computed tomography (CT) scan and adrenal scintigraphy using iodine-131 6beta-methyl-iodo-19-norcholesterol with the dexamethasone suppression test. Hormonal and scintigraphic examinations were conducted while avoiding interference by medical treatment. The aetiological diagnosis was established by taking account of the clinical context, the endocrine profile, and CT scan and scintigraphic data, as well as possible hormone assays after catheterization of the adrenal veins (12 cases) and postoperative pathology data (14 cases). The aetiological diagnoses established were Conn's adenoma (insensitive to angiotensin II) in 12 cases, idiopathic hyperplasia in 11 and macronodular hyperplasia (with functional autonomy of the nodules) in 18. Unilateral and bilateral lesions were correctly distinguished by scintigraphy in 92% of cases as compared with only 58% using CT scan alone; this was because the CT scan appearance was normal in 3/12 cases of adenoma and because a single nodule was visible in 2/11 cases of idiopathic hyperplasia and in 12/18 cases of macronodular hyperplasia. It is concluded that scintigraphy using noriodocholesterol with the dexamethasone suppression test should be performed systematically in conjunction with hormonal tests and adrenal CT scan in all cases of primary aldosteronism, as part of a strategy aimed not only at detecting adenoma but also at determining whether the hyperfunctional lesions are bilateral.

Topics: 19-Iodocholesterol; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Aged; Dexamethasone; Female; Humans; Hyperaldosteronism; Hyperplasia; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Tomography, X-Ray Computed

To assess the correlation value between adrenal venous sampling (AVS) and I-6β-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy in differentiating aldosterone-producing adenoma (APA) from bilateral idiopathic hyperaldosteronism (BHA), and the use of NP-59 scintigraphy as an alternative to AVS.. Overall, 29 patients with APA or BHA who underwent AVS and dexamethasone-suppression NP-59 scintigraphy were included between 2010 and 2017. The correlation value between AVS and dexamethasone-suppression NP-59 scintigraphy was assessed using each lateralisation index (LIAVS and LI1NP-59). Tumour presence and size were evaluated using computed tomography. The sensitivity and specificity of dexamethasone-suppression NP-59 scintigraphy for APA according to each lateralisation index threshold were calculated.. Of 29 patients, 12 presented with APA and 17 with BHA according to AVS. The correlation value between LIAVS and LI1NP-59 was 0.63 (P < 0.001). If the cut-off points were 2.55 and 1.80 in all cases, the sensitivity and specificity were 0.33 and 1.00 as well as 0.58 and 0.94, respectively. In adrenal microtumours (maximum diameter ≤10 mm), no cases revealed a cut-off point of >1.8. However, in adrenal macrotumours (maximum diameter >10 mm), the cut-off point of 2.55 represented the best compromise (sensitivity: 0.44; specificity: 1.00).. NP-59 scintigraphy can be used as an alternative to AVS if there is a strong lateralisation on NP-59 scintigraphy and adrenal macrotumours observed on the computed tomography when AVS is technically challenging, particularly in the right adrenal vein cannulation, and if contraindications, such as allergy to contrast materials and renal failure, are observed.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Adult; Aldosterone; Diagnosis, Differential; Female; Humans; Hyperaldosteronism; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Veins

Primary aldosteronism (PA) is a common cause of secondary hypertension. Among the many leading causes of PA, the two most frequent are, bilateral adrenal hyperplasia (BAH) and aldosterone-producing adenomas (APA). Since a solitary APA may be cured surgically, but BAH needs lifelong pharmacologic therapy, confirmation is mandatory before surgery. We herein sought to determine the diagnostic value of iodine-131 6-beta-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy to distinguish BAH from APA.. Patients clinically suspected of PA from March 2000 to October 2016 were retrospectively analyzed. A total of 145 patients, including 74 postunilateral adrenalectomy and seven postradiofrequency ablation for adrenal mass, were reviewed. All patients received NP-59 adrenal scintigraphy prior to surgery. The accuracy of the NP-59 adrenal scintigraphy was confirmed by the pathologic findings and postoperative outcomes.. Among 81 patients receiving interventional procedures for adrenal mass, adenoma was eventually diagnosed in 72 patients according to their pathologic results, with 60 unilaterally and seven bilaterally localized lesions by NP-59 scintigraphy; nevertheless, there were five negative findings initially. The sensitivity, specificity, and positive predictive value of NP-59 scintigraphy for APA detection were therefore 83.3, 44.4, and 92.3%, respectively. Moreover, single-photon emission computed tomography/computed tomography scan increased the sensitivity and specificity, but not the positive predictive value (85.0, 60.0, and 89.5%) of NP-59 scintigraphy in this study.. NP-59 adrenal scintigraphy is a useful imaging test to detect APA. Lateralization by this modality prior to surgical intervention may reduce the need for such invasive procedures as adrenal venous sampling.

Topics: 19-Iodocholesterol; Academic Medical Centers; Adrenal Glands; Adult; Aged; Female; Humans; Hyperaldosteronism; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Taiwan

Topics: 19-Iodocholesterol; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Asymptomatic Diseases; Cushing Syndrome; Dexamethasone; Female; Humans; Hydrocortisone; Incidental Findings; Iodine Radioisotopes; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Radiopharmaceuticals; Tomography, X-Ray Computed; Watchful Waiting

Topics: 19-Iodocholesterol; Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; False Negative Reactions; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Liver Neoplasms; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Tissue Distribution

The purpose of this article is to present our initial experience with hypersecretory adrenal syndromes investigated with radioiodinated I-6-B-iodomethyl-19-norcholesterol (NP-59) and SPECT-CT.. Illustrative cases are presented of patients being investigated for adrenal hypersecretory syndromes, with or without adrenal nodules, using NP-59 scintigraphy with SPECT-CT imaging, representing a spectrum of diagnoses. Clinical and imaging data are reviewed to evaluate whether additional information derived from near-simultaneous anatomic localization aids study interpretation.. The final diagnoses reached are hyperfunctional and nonfunctioning adrenal nodules, physiological bowel activity, and bilateral adrenal hyperplasia. SPECT-CT assisted study interpretation by localizing focal uptake to the adrenal glands, allowing direct assessment of function within adrenal nodules, and distinguishing physiological bowel activity from adrenal uptake. SPECT-CT provided additional information to planar and SPECT imaging, which improved confidence of study interpretation.. Utilization of SPECT-CT with NP-59 scintigraphy allows precise localization of the functional activity to anatomic structures improving diagnostic interpretation.

Topics: 19-Iodocholesterol; Adrenal Cortex; Adult; Aged; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Retrospective Studies; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The 2 main causes of primary aldosteronism (PA) are aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IAH). Dexamethasone-suppression (131)I-6beta-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy can assess the functioning of the adrenal cortex. This study evaluated the diagnostic usefulness of NP-59 SPECT/CT in differentiating APA from IAH and in predicting postadrenalectomy clinical outcome for PA patients who had inconclusive adrenal venous sampling (AVS) and CT results.. We retrospectively reviewed the 31 adrenal lesions of 27 patients (age range, 33-71 y; mean age +/- SD, 50.4 +/- 10.9 y) who had been clinically confirmed (by saline infusion and captopril tests) to have PA, had inconclusive CT and AVS test results, and had undergone NP-59 imaging before adrenalectomy. The accuracy of NP-59 imaging was determined by comparison with histopathologic findings.. NP-59 SPECT/CT gave us 18 true-positive, 3 false-positive, 6 true-negative, and 4 false-negative results. Compared with planar imaging, SPECT/CT significantly improved diagnostic accuracy and prognostic predicting ability (P = 0.0390 and P = 0.0141, respectively). The NP-59 results were negative for 7 of the 23 patients with unilateral adrenal lesions, and none of these 7 patients had shown postsurgical clinical improvement.. NP-59 SPECT/CT is an effective imaging tool for differentiating APA from IAH in PA patients whose CT and AVS results are inconclusive. Our results suggest that patients with presurgically negative NP-59 results should be treated medically and that noninvasive NP-59 SPECT/CT may be suited for use as the first lateralization modality after CT in patients with clinically confirmed PA.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Glands; Adrenalectomy; Adult; Aged; Diagnosis, Differential; Female; Humans; Hyperaldosteronism; Hyperplasia; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome; Veins

We experienced a case in which 131I-6beta-iodomethyl-19-norcholest-5(10)-en-3beta-ol (131I-adosterol) scintigraphy showed high uptake in the right adrenal gland. We diagnosed functional cortical adenoma because of the finding of 131I-adosterol scintigraphy. However, no positive findings for the existence of cortical adenoma were obtained in other examinations and we performed right adrenalectomy. Unexpectedly, pathological finding showed the right adrenal gland was occupied with a large ganglioneuroma. This is an instructive case in which 131I-adosterol scintigraphy showed abnormal high uptake in the adrenal gland, in spite of the fact that the adrenal gland was occupied by a tumor derived from adrenal medulla.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Gland Neoplasms; Adult; Diagnostic Errors; Ganglioneuroma; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals

Extraadrenal abnormal uptake on adrenocortical scintigraphy has been reported rarely in the normal gallbladder, lipid cell tumor of the ovary, or in clear cell type renal cell carcinoma. Clear cell type renal cell carcinoma contains glycogen and cholesterol like the adrenal gland, but the uptake of the radionuclide I-131 cholesterol has been reported to be low and not sufficient to image it. Right renal and adrenal masses were incidentally discovered on abdominal CT scan in a patient with chronic renal failure resulting in bilateral acquired cystic kidney disease. Adrenocortical scintigraphy done to know the nature of the adrenal mass showed high uptake corresponding to the right renal mass and the right adrenal mass. Clear cell type renal cell carcinoma and adrenal adenoma with prominent clear cells were histologically confirmed on hematoxylin-eosin stain and in an immunohistochemical study with renal cell antibody. Not only low-density lipoprotein receptors mediated uptake but also overall replacement of the right non-tumorous renal parenchyma by acquired cysts may have played a role in imaging the renal cell carcinoma on adrenocortical scintigraphy.

Topics: 19-Iodocholesterol; Adrenal Cortex Neoplasms; Adrenalectomy; Carcinoma, Renal Cell; Female; Humans; Kidney Neoplasms; Middle Aged; Nephrectomy; Radionuclide Imaging; Radiopharmaceuticals; Tomography, X-Ray Computed

Adrenocortical scintigraphy is a useful technique for differentiating between types of nonhyperfunctioning adrenal masses. Metastatic tumors do not normally accumulate radioiodocholesterol and show discordant uptake on scintigrams. We present two patients who showed accumulation of 131I-6beta-iodomethyl-19-norcholesterol (NP59) in the adrenal metastases from renal cell carcinoma. In one patient with bilateral adrenal metastases, accumulation in the primary tumor as well as adrenal metastases was demonstrated. The adrenal metastases in both patients were resected and were histologically proven to be metastases from clear-cell renal carcinoma. Accumulation of NP59 in metastatic adrenal tumors, although a very rare finding, suggests a pitfall in the differential diagnosis of adrenal cortical tumors.

Topics: 19-Iodocholesterol; Adrenal Gland Neoplasms; Aged; Carcinoma, Renal Cell; Female; Humans; Iodine Radioisotopes; Kidney Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals

A case of a 49-year-old man suffering from bilateral adrenocortical carcinoma with local and secondary rapid progression is reported. The results of adrenocortical scintigraphy (NP 59) and histological findings allowed the diagnosis. This case report and a literature review showed the importance of using adrenocortical scintigraphy as a complementary imaging procedure of CT or MR images.

Topics: 19-Iodocholesterol; Adrenal Cortex Neoplasms; Adrenalectomy; Antineoplastic Agents, Hormonal; Fatal Outcome; Humans; Male; Middle Aged; Mitotane; Radionuclide Imaging; Radiopharmaceuticals; Tomography, X-Ray Computed

Incidentally discovered adrenal masses are detected in 0.35% to 5. 00% of patients imaged with computed tomography (CT) for reasons other than suspected adrenal pathology. Most small adrenal masses are benign, although malignant tumors 2 cm. Although some lesions 1 to 2 to 1 to 2 to

Topics: 19-Iodocholesterol; Adrenal Gland Neoplasms; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Female; Humans; Incidence; Male; Middle Aged; Radionuclide Imaging; Tomography, X-Ray Computed

This is the case of a large 2 x 1.5 cm adrenal tumor demonstrated on CT scan that was proven biochemically and surgically to be an aldosteronoma and that did not concentrate 6-beta(131I)-iodo-methyl-19-norcholesterol (NP-59). Before the publication of this case, all CT-identified aldosteronomas of greater than 1 cm have concentrated NP-59. Previously, an adrenal mass of greater than 1 cm that failed to concentrate NP-59 was excluded from being an aldosteronoma. This concept must be reevaluated with the publication of this case.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Gland Neoplasms; False Negative Reactions; Female; Humans; Middle Aged; Radionuclide Imaging; Tomography, X-Ray Computed

The major etiologies of primary aldosteronism are aldosterone-producing adrenal adenoma, requiring a surgical treatment, and bilateral hyperplasia, usually managed with medical therapy. We only report a retrospective study on 22 patients with primary aldosteronism diagnosed by clinical and usual biochemical tests. All the patients were explored by computed tomography scan (CT) and iodomethyl-norcholesterol scintigraphy. The purpose of this study was to compare the capacity of the two methods to differentiate adrenal adenoma and hyperplasia. The CT scan was more sensitive (sensitivity: 88%) compare to scintigraphy (sensitivity: 64%) for the diagnosis of adrenal adenoma. However, the scintigraphy was a useful tool to detect asymmetric macronodular adrenal hyperplasia. Therefore, the catheterisation of adrenal venous would be only necessary for a few cases. We conclude from this study and the literature review that CT scan and iodomethyl-norcholesterol scintigraphy are complementary and both useful to increase diagnostic reliability of primary aldosteronism.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Adult; Aged; Diagnosis, Differential; Female; Humans; Hyperaldosteronism; Hyperplasia; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Tomography, X-Ray Computed

We reviewed the findings of adrenocortical scintigraphy with 131I-6-beta-iodomethyl-19-norcholesterol (NCL-6-131I) of 39 patients to clarify its role in the evaluation of unilateral adrenal or juxtaadrenal masses incidentally discovered by CT, ultrasonography or plain radiography. Twenty-seven benign adrenal masses showed various scintigraphic findings (hot nodule: 12 silent adenomas, warm nodule: one solid mass, normal appearance: one cyst and 2 solid masses, diffuse decrease: each one; solid mass, myelolipoma, ganglioneuroma and calcified adrenal and partial or complete defect: each one; solid mass, myelolipoma and ganglioneuroma and 2 cysts and 2 pheochromocytomas); while a partial or complete defect was shown in a nonfunctioning carcinoma and 3 metastases and a complete defect or inhomogeneous uptake without opposite adrenal visualization was shown in 2 patients with cortisol-producing carcinoma. Therefore a hot nodule and an inhomogeneous uptake or complete defect with nonvisualization of the opposite adrenal are specific to a benign tumor and a cortisol-producing carcinoma, respectively. The impaired tumor uptake of NCL-6-131I is a nonspecific finding. The scintigraphic findings of juxtaadrenal masses were normal in 4 and deviated adrenals in 2. Thus adrenocortical scintigraphy can identify silent adenomas and cortisol-producing carcinomas among the adrenal masses and may help to differentiate juxtaadrenal from adrenal masses.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Gland Neoplasms; Adrenocortical Adenoma; Adult; Carcinoma, Renal Cell; Female; Ganglioneuroma; Humans; Male; Middle Aged; Myelolipoma; Neurilemmoma; Pheochromocytoma; Radionuclide Imaging; Tomography, X-Ray Computed; Ultrasonography

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex; Adrenal Cortex Neoplasms; Cholesterol; Humans; Iodine Radioisotopes; Radionuclide Imaging; Selenium Radioisotopes

Current clinical teaching indicates that large (greater than 5 cm in diameter) adrenal masses are often malignant. In a retrospective analysis of patients studied between 1977 and 1988 with computed tomography (CT), adrenal scintigraphy, and when available, magnetic resonance imaging (MRI) 45 were found to have adrenal masses greater than 5 cm (range 5-19 cm) in diameter. Thirty were benign (16 phaeochromocytomas, six adrenocortical adenomas, four adrenal cysts, two myelolipomas, an adrenal hematoma and a ganglioneuroma). Of 15 malignant masses, there were seven adrenocortical carcinomas, five adrenal metastases and three adrenal lymphomas. With the exception of the adrenal myelolipomas, cysts, and the ganglioneuroma neither CT nor MRI demonstrated sufficient diagnostic specificity to distinguish benign from malignant lesions. Functional scintigraphy with 131I-6-beta-iodomethyl-19-norcholesterol for suspected adrenocortical lesions and 131I-metaiodobenzylguanidine for suspected phaeochromocytomas frequently provided useful information.

Topics: 19-Iodocholesterol; 3-Iodobenzylguanidine; Adrenal Gland Neoplasms; Adrenal Glands; Adult; Aged; Aged, 80 and over; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Tomography, X-Ray Computed

A patient with bilateral adrenal hyperplasia, due to the ectopic adrenocorticotrophic hormone (ACTH) syndrome, received a 3-month course of treatment with 1,1 dichloro-2(o-chlorophenyl)-2-(p-chlorophenyl)ethane (o,p' DDD), which caused adrenal hypofunction requiring steroid therapy. Eleven months later, Cushing's syndrome recurred. His CT scan showed a left adrenal gland that was enlarged and a normal-sized right adrenal gland. However, the NP-59 image showed increased uptake by both glands. Venous effluent was sampled from each adrenal vein. The plasma cortisol level from the left gland was 1392 ng/ml, and that from the right gland was 667 ng/ml. The latter value was not significantly different from the values obtained at peripheral sites (517-744 ng/ml). In the course of recovery from o,p' DDD damage, the ability of the adrenal gland to take up NP-59 may be restored before the return of its biosynthetic and secretory functions. Serial NP-59 adrenal images can anticipate the recurrence of Cushing's syndrome after adrenolytic therapy, thereby permitting early retreatment.

Topics: 19-Iodocholesterol; ACTH Syndrome, Ectopic; Adrenal Glands; Adult; Cholesterol; Humans; Iodine Radioisotopes; Male; Mitotane; Paraneoplastic Endocrine Syndromes; Radionuclide Imaging; Recurrence

To assess the efficacy of 131I-6-beta-iodomethylnorcholesterol scintigraphy in the adrenocorticotropic hormone-independent Cushing syndrome and to compare this with computed tomography.. Retrospective analysis of case series from 1977 to 1987.. Referral to the Division of Nuclear Medicine at a tertiary-care university medical center.. Twenty-four patients with a pathologically-confirmed diagnosis of the adrenocorticotropic hormone-independent Cushing syndrome had 131I-6-beta-iodomethylnorcholesterol scintigraphy and, in most cases, computed tomography.. Using 131I-6-beta-iodomethylnorcholesterol scintigraphy, adenomas were accurately seen as focal, unilateral tracer uptake in 14 of 14 patients. In carcinoma, the classic scintigraphic pattern of bilateral nonvisualization was observed in 3 of 4 patients, with ipsilateral uptake of tracer in 1 patient with a histologically well-differentiated malignancy. Computed tomography done during the same interval depicted abnormal adrenals in all cases of adenoma and carcinoma. In cortical nodular hyperplasia, however, computed tomography identified abnormal pairs of adrenals in only one of four cases studied, whereas scintigraphy showed typical patterns of bilateral increased uptake in all of the cases.. 131I-6-beta-iodomethylnorcholesterol scintigraphy accurately shows the location and nature of adrenal dysfunction in the adrenocorticotropic hormone-independent Cushing syndrome and may be particularly useful in identifying the bilateral adrenal involvement in cortical nodular hyperplasia.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex; Adrenal Cortex Diseases; Adrenal Cortex Neoplasms; Carcinoma; Cholesterol; Cushing Syndrome; Evaluation Studies as Topic; Female; Humans; Hyperplasia; Iodine Radioisotopes; Male; Radionuclide Imaging; Retrospective Studies; Tomography, X-Ray Computed

To determine the efficacy of 131I-6-beta-iodomethylnorcholesterol (NP-59) adrenal scintigraphy in distinguishing benign from malignant euadrenal masses.. Case series of patients with incidentally discovered unilateral, euadrenal masses.. Referral-based nuclear medicine clinics at university and affiliated Veterans Administration medical centers.. Consecutive sample of 119 euadrenal patients with unilateral adrenal masses discovered on computed tomographic (CT) scans for reasons other than suspected adrenal disease.. Adrenal scintiscans done using 1 mCi of NP-59 intravenously, and gamma camera imaging 5 to 7 days later.. Mean lesion diameter was 3.3 +/- 1.9 cm (SD) (95% CI: 2.9 to 3.6 cm). In 76 patients, NP-59 uptake lateralized to the abnormal adrenal seen on CT scans (concordant imaging), and in all of these patients, a diagnosis of adenoma was made by needle-aspiration biopsy, adrenalectomy, or extended follow-up with repeat CT scans that were unchanged at 6 months or later. Twenty-six patients had absent or markedly reduced NP-59 uptake in the glands identified as abnormal on CT scans (discordant imaging). These adrenal masses proved to be metastatic malignancies in 19 patients, primary adrenal neoplasms other than adenoma in 4, and adrenal cysts in 3. Bilateral, symmetric accumulation of NP-59 was seen in 17 patients, in whom the adrenal masses were shown to be metastatic malignancies in 2, and adenomas in 6 (the lesions in these cases being 2 cm or less in diameter), and lesions not truly involving the adrenal in the rest (periadrenal metastases in 4 and pseudoadrenal masses in 5). Sensitivity was 76% (26 of 34 patients; CI, 58% to 88%); specificity, 100% (85 of 85 patients; CI, 95% to 100%), and accuracy, 93% (111 of 119 patients: CI, 88% to 98%).. Functional NP-59 scintigraphy can be used to accurately and noninvasively characterize many euadrenal masses; concordance of CT and NP-59 scans can be used to exclude the presence of a malignancy or other space-occupying adrenal lesion.

Topics: 19-Iodocholesterol; Adenoma; Adolescent; Adrenal Cortex; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adult; Aged; Aged, 80 and over; Cholesterol; Cysts; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Tomography, X-Ray Computed

The exact localization of adrenal lesions can be achieved by noninvasive procedures. Whereas radiological methods reflect morphological changes, scintigraphy of adrenal cortex and medulla depends on function. - Radiolabeled 6 beta-methyl-19-norcholesterol is used for adrenocortical scintigraphy in primary aldosteronism, Cushing's syndrome and hyperandrogenism. By dexamethasone suppression a correct classification of adrenocortical lesions by scintigraphy can be observed in about 89% with a specificity of 86%. 123-I- and 131-I-metaiodobenzylguanidine is used for specific scintigraphy of the adrenal medulla. This method is a safe and reliable method for localization of adrenal and extraadrenal pheochromocytomas.

Topics: 19-Iodocholesterol; 3-Iodobenzylguanidine; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Cholesterol; Cushing Syndrome; Dexamethasone; Humans; Hyperaldosteronism; Iodobenzenes; Pheochromocytoma; Radionuclide Imaging; Selenium; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

I-131-6 beta-iodomethylnorcholesterol (NP-59) was used to localize mineralocorticoid-secreting adrenocortical carcinomas in two patients and functioning metastases in a third patient studied after the removal of the primary tumor. The presence of sufficient NP-59 activity within these lesions for discernable imaging is unusual and would not have been expected based on previous experience with other functioning and nonfunctioning carcinomas of the adrenal cortex. These cases serve to illustrate the variable spectrum of iodocholesterol uptake into adrenocortical malignancies and suggest that scintigraphic studies, preoperatively for localization and postoperatively to confirm the presence of recurrence or metastases, might be useful to identify and characterize these rare neoplasms.

Topics: 19-Iodocholesterol; Adrenal Cortex Neoplasms; Adult; Carcinoma; Catecholamines; Cholesterol; Female; Humans; Hyperaldosteronism; Iodine Radioisotopes; Male; Middle Aged; Mineralocorticoids; Neoplasm Metastasis; Radionuclide Imaging; Steroids; Tomography, X-Ray Computed

The enterohepatic circulation and distribution of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) was assessed in a rabbit model to examine the relative distribution of NP-59 and its metabolites. Adrenal, bile and serum samples were obtained from seven rabbits at 48 h following NP-59 administration (240 to 570 microCi) and the distribution of 131I radioactivity examined using thin layer chromatography. In serum 71% of the radioactivity circulated as NP-59 and 20% as NP-59 esters. In contrast greater than 90% of the adrenal radioactivity was in the form of NP-59 esters while in bile 70% of the activity was NP-59 with the remainder in the form of bile acids. In another group of animals, adrenal activity was observed 5 days after intragastric administration of NP-59. Thus, we have demonstrated a significant enterohepatic circulation of NP-59 that may have the potential to influence the distribution of and resultant adrenal imaging with NP-59.

Topics: 19-Iodocholesterol; Adrenal Cortex; Animals; Bile; Cholesterol; Enterohepatic Circulation; Esters; Iodine Radioisotopes; Models, Biological; Rabbits; Radionuclide Imaging

The biodistribution of 131I-6 beta-iodomethyl-19-norcholesterol (NP-59) was assessed in hypercholesterolaemic patients and in a rabbit model of HC to examine the alterations in the relative distribution of NP-59 and its metabolites and to explain the changes in the patterns of adrenal cortical imaging in patients with expanded cholesterol pools. Rabbits were rendered hypercholesterolaemic with a diet supplemented with 2% cholesterol for 2 weeks prior to the intravenous administration of 240 to 570 microCi of NP-59. Adrenal, bile and serum samples were obtained from four hypercholesterolaemic rabbits at 48 h following NP-59 administration, and the distribution of 131I radioactivity was compared to that of seven rabbits maintained on a standard laboratory diet. Serum cholesterol levels were 1940 +/- 248 mg dl-1 in the hypercholesterolaemic rabbits as compared to 268 +/- 62 mg dl-1 in the controls. Adrenal cortical uptake of NP-59 was decreased in HC rabbits but no significant differences were observed in the relative proportions of NP-59 or its metabolites in the bile and adrenal tissues of hypercholesterolaemic versus control animals. Hypercholesterolaemic animals did exhibit an increase in NP-59 esters in serum as compared to controls. In three of five patients with hypercholesterolaemia, adrenal uptake of NP-59 was enhanced after successful lowering of serum cholesterol levels, while the remaining two patients who responded inadequately to cholesterol-lowering therapy showed a slight drop in NP-59 uptake.

Topics: 19-Iodocholesterol; Adrenal Cortex; Animals; Bile; Cholesterol; Colestipol; Disease Models, Animal; Esters; Humans; Hypercholesterolemia; Iodine Radioisotopes; Male; Niacin; Rabbits; Radionuclide Imaging; Triglycerides

To assess whether a single measurement of the adrenal uptake of 6 beta-[131I]-iodomethylnorcholesterol (NP-59) on constant dexamethasone suppression would allow discrimination of adenoma from normal and bilateral hyperplasia, the adrenal uptake of 6 beta-[131I]iodomethylnorcholesterol (NP-59) was determined in 50 patients with primary aldosteronism (30 adenoma, 20 hyperplasia) and in 13 with hyperandrogenism (six adenoma, seven hyperplasia). Bilateral adrenal NP-59 activity at 5 days was seen in 14 of 36 patients with adenoma (normal to adenoma ratio of greater than or equal to 0.5), whereas marked asymmetric uptake of NP-59 was seen in six of 27 patients with hyperplasia (uptake ratio of less than or equal to 0.5). Thus the level of adrenal NP-59 uptake does not alone serve to distinguish either adenoma from the normal, contralateral adrenal or the adrenal glands in bilateral hyperplasia in all cases. It appears that the pattern of adrenal imaging, early unilateral or early bilateral NP-59 activity (less than 5 days after NP-59 on 4 mg dexamethasone), best serves to separate adrenal adenoma from bilateral hyperplasia.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex; Adrenal Cortex Neoplasms; Adrenocorticotropic Hormone; Androgens; Dexamethasone; Diagnosis, Differential; Humans; Hyperaldosteronism; Hyperplasia; Radionuclide Imaging

Thirty-three adrenal scintigrams in 30 patients were reviewed to determine the utility of this noninvasive imaging technique. It was found to be very accurate in distinguishing bilateral from unilateral hyperfunction in patients who have clinical and biochemical evidence of adrenal cortical hyperfunction. The technique proved correct in 12 of 12 cases of Cushing's syndrome and 14 of 19 cases of hyperaldosteronism. Specific clinical questions were also answered in three miscellaneous cases.

Topics: 19-Iodocholesterol; Adrenal Glands; Adult; Aged; Cushing Syndrome; Female; Humans; Hyperaldosteronism; Male; Middle Aged; Radionuclide Imaging

Dexamethasone suppression (DS) adrenal cortical scintigraphy has been shown to be useful in the detection of the adrenal pathology in women with hyperandrogenism. However, a relationship between adrenal cortical uptake of I-131 6 beta-iodomethylnorcholesterol (NP-59) and the level of adrenal androgen secretion has not been established. A retrospective analysis of DS adrenal scintiscans has been performed on 39 women with hirsutism and hyperandrogenism. In 14 patients with normal patterns of imaging, in vivo adrenal gland iodocholesterol uptake, calculated using a semi-operator-independent-computer algorithm, did not correlate with the excretion of urinary 17-ketosteroids (17-KS). In contrast, in 20 patients demonstrating abnormal bilateral early imaging patterns, adrenal gland NP-59 uptake correlated significantly with the level of urinary 17-KS excretion (r = 0.65, P less than 0.05). To date seven of these 20 patients have had confirmatory procedures documenting the adrenal glands as contributing sites of androgen secretion. A similar correlation with urinary 17-KS excretion was seen in five other patients with unilateral imaging patterns (r = 0.94, P less than 0.005), due to androgen-secreting adrenal cortical adenomas. No correlation between adrenal NP-59 uptake and plasma testosterone or dehydroepiandrosterone sulphate levels was observed in any of the groups. Thus, adrenal gland uptake of NP-59 under DS reflects a measure of androgen secretion in women with androgen excess.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; 19-Iodocholesterol; Adolescent; Adrenal Cortex; Adult; Androgens; Cholesterol; Dehydroepiandrosterone; Dexamethasone; Female; Hirsutism; Humans; Radionuclide Imaging; Testosterone

ACTH-stimulation adrenal imaging (ACTH-I) was performed in 14 patients after baseline imaging (B-I) was performed. In six patients with no adrenal diseases in whom the findings of B-I were equivocal, morphologic normality of the adrenals was confirmed by ACTH-I because of increased adrenal uptake of radioiodocholesterol. In three patients with cortisol-producing tumors, visualization of contralateral glands by ACTH-I provided indirect evidence for autonomous cortisol secretion of the tumors. In three patients with pheochromocytoma or cyst, ACTH-I increased adjacent cortical radioactivity to more clearly delineate the lesions. In two patients with primary adrenocortical insufficiency, exogenous ACTH had no effect on adrenal uptake of the tracer. Correlation was observed between response of the adrenal net counts and urinary excretion of 17-OHCS and 17-KS. ACTH-I is useful when B-I does not provide sufficient diagnostic information or further information is needed due to low or absent radioiodocholesterol uptake by the adrenal gland(s).

Topics: 17-Ketosteroids; 19-Iodocholesterol; Addison Disease; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Aged; Cholesterol; Female; Humans; Hypertension; Male; Middle Aged; Pituitary-Adrenal Function Tests; Radionuclide Imaging

Topics: 19-Iodocholesterol; Adrenal Glands; Animals; Cholagogues and Choleretics; Cholesterol; Iodine Radioisotopes; Male; Radioactivity; Radionuclide Imaging; Rats; Rats, Inbred Strains; Tissue Distribution

The use of radiolabeled cholesterol derivatives for functional imaging of the adrenal cortex may be rendered inaccurate or impossible because of the excretion of activity by the liver and its subsequent appearance in the colon. A simple bowel preparation (bisacodyl 5 or 10 mg nightly) significantly reduced bowel background activity during 6 beta-[I-131]iodomethyl-19-norcholesterol (NP-59) adrenal cortical scintigraphy. Activity interfering with image interpretability was present less frequently in patients taking bisacodyl: three days after injection 22% compared with 59%; five days after injection 23% compared with 35%. As bisacodyl acts only on the colon and does not disturb the enterohepatic circulation of cholesterol or bile acids, it is ideal for use with a tracer of cholesterol metabolism.

Topics: 19-Iodocholesterol; Adrenal Cortex; Bisacodyl; Cholesterol; Colon; Cresols; Humans; Radionuclide Imaging

Topics: 19-Iodocholesterol; Adosterol; Adrenal Glands; Adult; Aged; Cholesterol; Cushing Syndrome; Evaluation Studies as Topic; Female; Humans; Hyperaldosteronism; Infant; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Sterols