19-iodocholesterol and Carcinoma

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

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 results of scintigraphy in 29 patients with Cushing's syndrome were evaluated. It was possible to separate bilateral hyperplasia from unilateral abnormality. In cases of unilateral abnormality correct localization of the tumour was accomplished and it was possible to visualize adrenocortical carcinoma. The many advantages of adrenal scintigraphy are listed and it is concluded that adrenal scintigraphy is the best means of investigation to differentiate between ACTH-dependent and ACTH-independent Cushing's syndrome.

Topics: 19-Iodocholesterol; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Adrenal Hyperplasia, Congenital; Adrenocorticotropic Hormone; Adult; Aged; Carcinoma; Cushing Syndrome; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging

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; Adrenal Gland Neoplasms; Adrenal Glands; Bronchoscopy; Carcinoma; Cholesterol; Humans; Lung Neoplasms; Male; Middle Aged; 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