19-iodocholesterol and Hyperplasia

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

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

In order to differentiate an aldosterone producing adenoma (APA) and a bilateral adrenal hyperplasia (BAH) in case of primary hyperaldosteronism, an adrenal CT-scan is usually used as first line exploration. The contribution of adrenal 19-noriodocholesterol (NP59)-scintigraphy is controversial.. We describe 17 cases of primary hyperaldosteronism referred to surgery for suspected APA. The value of abdominal CT-scan and of adrenal scintigraphy was studied.. After unilateral adrenalectomy, 15 cases with confirmed APA were cured and 2 cases with an unilateral hyperplastic macro nodule showed persistence of the disease. The pathologic findings were concordant with CT-scan in 76% (13/17) and with scintigraphy in 88% (15/17). Similar sensitivity was found for CT-scan and scintigraphy (86% and 88%) with 2 false negative results with both techniques. False positive results were observed only with CT-scan (2 cases) suggesting that scintigraphy has a better specificity. No case was misdiagnosed by both techniques.. These results suggest that NP59-scintigraphy is complementary to adrenal CT-scan for the recognition of APA and is particularly useful in case of a unilateral hyperplastic macro nodule mimicking an APA.

Topics: 19-Iodocholesterol; Adrenal Glands; Adult; Aged; Contrast Media; Diagnosis, Differential; Female; Humans; Hyperaldosteronism; Hyperplasia; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; 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

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 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

In primary aldosteronism the type of adrenal lesion was correctly identified in 28 of 40 patients (70%) by standard adrenal scintigraphy. Suppression scintigraphy did not improve the validity of the method. In all patients the diagnosis was confirmed by surgery (unilateral adenoma n = 32; bilateral adrenal hyperplasia n = 11). False classification of the adrenal lesion(s) by standard scintigraphy was mostly due to a bilateral adrenal isotopic uptake in patients with an unilateral aldosteronoma. However, a substantial number of these patients (6 of 11 patients) received long-term spironolactone treatment prior to the examination. Thus, in primary aldosteronism adrenal changes induced by chronic spironolactone administration are probably a major cause for incorrect differentiation between adenoma and hyperplasia by adrenal scintigraphy.

Topics: 19-Iodocholesterol; Adenoma; Adosterol; Adrenal Gland Neoplasms; Adult; False Positive Reactions; Female; Humans; Hyperaldosteronism; Hyperplasia; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Spironolactone

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