19-iodocholesterol and Adrenal-Cortex-Neoplasms

In the setting of adrenal incidentaloma, nuclear medicine evaluation is only indicated after biological and imaging work-up has been completed. MIBG scintigraphy is helpful to characterize pheochromocytomas. In lesions without MIBG uptake, 18F FDG or 18F DOPA PET can be considered to characterize chromaffin cell tumours. To characterize lesions of the adrenal cortex, iodocholesterol scintigraphy is performed to confirm the origin of the adenoma and the benign or malignant nature of the lesion since benign adenomas show tracer uptake and malignant lesions show no tracer uptake. 18F FDG PET only characterizes the lesion as benign or malignant.

Topics: 19-Iodocholesterol; 3-Iodobenzylguanidine; Adenoma; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adult; Dihydroxyphenylalanine; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Incidental Findings; Pheochromocytoma; Positron-Emission Tomography; Radiopharmaceuticals

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

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Adult; Aged; Asymptomatic Diseases; Cushing Syndrome; Female; Humans; Hydrocortisone; Limit of Detection; Male; Middle Aged; Pituitary-Adrenal Function Tests; Radionuclide Imaging; Retrospective Studies

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

Topics: 19-Iodocholesterol; Adrenal Cortex Neoplasms; Adrenal Gland Diseases; Adrenal Glands; Adrenocortical Adenoma; Cushing Syndrome; Diagnosis, Differential; Female; Humans; Hydrocortisone; Middle Aged; Radionuclide Imaging; Tomography, X-Ray Computed; Urination Disorders

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

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

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

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

A case is described without clinical and hormonal data about Icenko-Cushing syndrome, with a scintigraphy of adrenals demonstrating the image, characteristic for corticosteroma (decompensated node). The most probable explanation of the finding is that the tumour is with restricted secretory possibilities and secrets mainly biologically inactive hormones, and furthermore it is not with an autonomous, but ACTH-dependent hormonal production.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex Hormones; Adrenal Cortex Neoplasms; Cholesterol; Cushing Syndrome; Female; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging

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

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

Referral patterns from internists to departments of nuclear medicine or radiology are important determinants of whether adrenal glands are imaged by computed tomography (CT) or by radioisotope scintigraphy. To assist clinicians in making an informed choice, computed tomographic scans were compared with isotope scintigrams using 131I-19-iodocholesterol (19-IC) and 131I-6 beta-iodomethyl-19-norcholesterol (NP-59). In general, imaging techniques serve to localize diseases that are diagnosed on the basis of biochemical tests of adrenal function. Computed tomographic scanning and NP-59 scanning are of comparable diagnostic accuracy. Both are superior to 19-IC scanning in the diagnosis of Cushing's syndrome and primary aldosteronism. Computed tomographic scanning is faster and less expensive, and involves lower radiation doses to the patient than scintigraphy. Adrenocortical isotope scanning as a routine procedure has been superseded by computed tomographic scanning at the Mayo Clinic.

Topics: 19-Iodocholesterol; Adosterol; Adrenal Cortex; Adrenal Cortex Diseases; Adrenal Cortex Neoplasms; Adult; Aged; Cushing Syndrome; Female; Humans; Hyperaldosteronism; Male; Middle Aged; Radionuclide Imaging; Tomography, X-Ray Computed

Twelve cases of aldosteronoma were evaluated with CT and radioisotope scintigraphy to compare the diagnostic capability of both methods. All cases were diagnosed with scintigraphy, while six of 12 cases were diagnosed with CT. However, considering that nuclear imaging requires seven or eight days for evaluation, and the radiation dose is relatively high, it seems reasonable to perform CT scans initially in the localization of an aldosteronoma and to include scintigraphy in those cases in which aldosteronoma is not demonstrated by CT.

Topics: 19-Iodocholesterol; Adrenal Cortex Neoplasms; Adrenal Glands; Adult; Aldosterone; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Tomography, X-Ray Computed

To correlate iodocholesterol tissue uptake with the ability to visualize adrenal cortical neoplasms, eight female patients with adrenal carcinoma had adrenal scintiscans after the injection of 19-[131I]iodocholesterol. Patients with cortisol-secreting carcinomas failed to image either the tumor or uninvolved adrenal tissue. In contrast, patients with androgen-secreting carcinomas (which do not suppress pituitary ACTH secretion), although still failing to image the tumor, had visible concentration of the radionuclide in the ipsilateral and contralateral adrenal glands. Slices of these tissues obtained at either surgery or postmortem examination were analyzed for iodocholesterol uptake. Results were compared with adrenal tissue obtained from patients with either cortisol- or aldosterone-secreting adenomas and patients on dexamethasone suppression. There was a strong correlation between the adrenal tissue concentration of iodocholesterol and the ability to form an image on scintiscanning. The concentration of iodocholesterol in an adenoma and a carcinoma determined in this manner was compared with their cortisol secretion during in vitro incubation. The concentration of 19-[131I]iodocholesterol and the in vitro secretion of cortisol were greater in the adenoma than in the carcinoma and corresponded with adrenal imaging in the former and lack of imaging in the latter. These data provide a quantitative assessment of the differences in radioactivity concentration required for imaging of adrenal tumors. It also demonstrates that differences in the concentration of radioactivity within adrenal carcinomas and adenomas corresponds to their ability to release cortisol in vitro.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex Neoplasms; Androgens; Carcinoma; Cholesterol; Female; Humans; Hydrocortisone; Iodine Radioisotopes; Radionuclide Imaging

Topics: 19-Iodocholesterol; Adolescent; Adrenal Cortex Neoplasms; Adrenocortical Hyperfunction; Adult; Cushing Syndrome; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiography; Radionuclide Imaging

Adrenal scintiscanning and venography with sampling of adrenal venous blood are valuable methods to localize adrenal cortical lesions of Cushing's syndrome and primary aldosteronism. Adrenal scintiscanning with dexamethasone suppression is most useful in differentiating adenoma from hyperplasia of primary aldosteronism.

Topics: 19-Iodocholesterol; Adrenal Cortex Neoplasms; Adrenal Glands; Cholesterol; Cushing Syndrome; Humans; Hyperaldosteronism; Phlebography; Radionuclide Imaging

Topics: 19-Iodocholesterol; Adrenal Cortex; Adrenal Cortex Neoplasms; Adult; Carcinoma; Child; Female; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Time Factors

Seven patients with Cushing's syndrome secondary to adrenocortical tumors were studied using 131I-19-iodocholesterol. The diagnosis of all cases were verified histologically. In three cases with adenoma the uptake of the tracer was in the tumor only, while the two patients with adrenocortical carcinoma failed to show adrenal accumulation of the labelled compound. In two patients there was a hyperplasia-like scintigraphic pattern, while the stimulation and suppression biochemical tests suggested adrenal tumor. One of these cases was verified as a mixed form (adenoma plus hyperplasia), and the tumor bearing gland was significantly larger on the scan which helped the preoperative localization. In the other case, verified as bilateral multiple adrenocortical adenomas, the autonomus function of both adrenals was proved by dexamethasone suppression scanning. It seens reasonable to use the latter as an adunctive diagnostic procedure in patients where there is a discrepancy between the standart scintiscan and the biochemical indexes of adrenal hyperfunction.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Cortex; Adrenal Cortex Neoplasms; Carcinoma; Cushing Syndrome; Humans; Hyperplasia; Iodine Radioisotopes; Radionuclide Imaging