Horm Metab Res 2017; 49(12): 929-935
DOI: 10.1055/s-0043-120672
Review
© Georg Thieme Verlag KG Stuttgart · New York

The Latest Developments of Functional Molecular Imaging in the Diagnosis of Primary Aldosteronism

Mitsuhide Naruse
1   Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Hironobu Umakoshi
1   Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2   Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Mika Tsuiki
1   Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2   Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Maki Yokomoto
1   Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2   Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Tetsuya Tagami
1   Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
2   Division of Endocrinology and Metabolism, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
,
Akiyo Tanabe
3   Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan
,
Akira Shimatsu
1   Clinical Research Institute of Endocrinology and Metabolic Diseases, Kyoto Medical Center, National Hospital Organization, Kyoto, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

received 21. August 2017

accepted 28. September 2017

Publikationsdatum:
23. November 2017 (online)

Abstract

Differentiation of unilateral from bilateral aldosterone hypersecretion is the essential step in the clinical practice of primary aldosteronism (PA). Although adrenal venous sampling (AVS) has been established as the most standard test recommended by the guideline, its invasive and technically difficult nature has facilitated the approach to develop non-invasive functioning imaging as an alternative test. Compared to the conventional adrenocortical scintigraphy with cholesterol derivatives as tracer, the first-generation imaging, both of 11C-MTO/PET and 123I-IMTO/SPECT/CT, the second-generation imaging, bind with high specificity and affinity to CYP11B enzymes and have advantages in shortening the time for obtaining specific images, reducing the radiation exposure to the patient, and resolution of the images. Because of very short half-life of 11C-MTO, 123I-IMTO has a potential for a wider application than 11C-MTO. Sensitivity of identifying an adenoma smaller than 1 cm in diameter is still a common limitation of these new functional imaging methods. The new functional imaging could be supplementary to AVS in lateralization of PA when the results of AVS are not conclusive. To be a substitute for AVS, however, it should fulfill various conditions including high selectivity and binding affinity to CYP11B2, high sensitivity in detecting small adenoma, high resolution image, reduction of radiation exposure, and general versatility. Considering the potential number of patients, cost-effectiveness of the subtype testing in the clinical practice of PA could be one of the issues of the medical expenses. Thus, development of a new non-invasive functional imaging will have a significant impact on the clinical practice of PA and hypertension.

 
  • References

  • 1 Gordon RD, Stowasser M, Rutherford JC. Primary aldosteronism: are we diagnosing and operating on too few patients?. World J Surg 2001; 25: 941-947
  • 2 Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004; 136: 1227-1235
  • 3 Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, Young Jr WF. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016; 101: 1889-1916
  • 4 Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol 2007; 66: 607-618
  • 5 Conn JW, Morita R, Cohen EL, Beierwaltes WH, McDonald WJ, Herwig KR. Primary aldosteronism. Photoscanning of tumors after administration of 131 I-19-iodocholesterol. Arch Intern Med 1972; 129: 417-425
  • 6 Sarkar SD, Cohen EL, Beierwaltes WH, Ice RD, Cooper R, Gold EN. A new and superior adrenal imaging agent, 131I-6beta-iodomethyl-19-nor-cholesterol (NP-59): evaluation in humans. J Clin Endocrinol Metab 1977; 45: 353-362
  • 7 Rubello D, Bui C, Casara D, Gross MD, Fig LM, Shapiro B. Functional scintigraphy of the adrenal gland. Eur J Endocrinol 2002; 147: 13-28
  • 8 Gross MD, Shapiro B, Francis IR, Glazer GM, Bree RL, Arcomano MA, Schteingart DE, McLeod MK, Sanfield JA, Thompson NW. Scintigraphic evaluation of clinically silent adrenal masses. J Nucl Med 1994; 35: 1145-1152
  • 9 Lombardi CP, Raffaelli M, De Crea C, Rufini V, Treglia G, Bellantone R. Noninvasive adrenal imaging in hyperaldosteronism: is it accurate for correctly identifying patients who should be selected for surgery?. Langenbecks Arch Surg 2007; 392: 623-628
  • 10 Hogan MJ, McRae J, Schambelan M, Biglieri EG. Location of aldosterone-producing adenomas with 131I-19-iodocholesterol. N Engl J Med 1976; 294: 410-414
  • 11 Nomura K, Kusakabe K, Maki M, Ito Y, Aiba M, Demura H. Iodomethylnorcholesterol uptake in an aldosteronoma shown by dexamethasone- suppression scintigraphy: relationship to adenoma size and functional activity. J Clin Endocrinol Metab 1990; 71: 825-830
  • 12 Kempers MJ, Lenders JW, van Outheusden L, van der Wilt GJ, Schultze Kool LJ, Hermus AR, Deinum J. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 2009; 151: 329-337
  • 13 Mansoor GA, Malchoff CD, Arici MH, Karimeddini MK, Whalen GF. Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of I-131 norcholesterol scanning. Am J Hypertens 2002; 15: 459-464
  • 14 Yen RF, Wu VC, Liu KL, Cheng MF, Wu YW, Chueh SC, Lin WC, Wu KD, Tzen KY, Lu CC. TAIPAI Study Group . 131I-6beta-iodomethyl-19-norcholesterol SPECT/CT for primary aldosteronism patients with inconclusive adrenal venous sampling and CT results. J Nucl Med 2009; 50: 1631-1637
  • 15 Bergström M, Bonasera TA, Lu L, Bergström E, Backlin C, Juhlin C, Långström B. In vitro and in vivo primate evaluation of carbon-11-etomidate and carbon-11-metomidate as potential tracers for PET imaging of the adrenal cortex and its tumors. J Nucl Med 1998; 39: 982-989
  • 16 Bergström M, Juhlin C, Bonasera TA, Sundin A, Rastad J, Akerström G, Långström B. PET imaging of adrenal cortical tumors with the 11beta-hydroxylase tracer 11C-metomidate. J Nucl Med 2000; 41: 275-282
  • 17 Zettinig G, Mitterhauser M, Wadsak W, Becherer A, Pirich C, Vierhapper H, Niederle B, Dudczak R, Kletter K. Positron emission tomography imaging of adrenal masses: (18) F-fluorodeoxyglucose and the 11beta-hydroxylase tracer (11) C-metomidate. Eur J Nucl Med Mol Imaging 2004; 31: 1224-1230
  • 18 Hennings J, Lindhe O, Bergström M, Långström B, Sundin A, Hellman P. 11C- metomidate positron emission tomography of adrenocortical tumors in correlation with histopathological findings. J Clin Endocrinol Metab 2006; 91: 1410-1414
  • 19 Hennings J, Sundin A, Hägg A, Hellman P. 11C-metomidate positron emission tomography after dexamethasone suppression for detection of small adrenocortical adenomas in primary aldosteronism. Langenbecks Arch Surg 2010; 395: 963-967
  • 20 Burton TJ, Mackenzie IS, Balan K, Koo B, Bird N, Soloviev DV, Azizan EA, Aigbirhio F, Gurnell M, Brown MJ. Evaluation of the sensitivity and specificity of (11) C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn's adenomas. J Clin Endocrinol Metab 2012; 97: 100-109
  • 21 O’Donoghue D, Joyce M, O’Sullivan G, O’ Shea PM, Quill D, Lowery A, Bashari W, Powlson AS, Lappin D, Gurnell M, Dennedy MC. 11C Metomidate PET/CT successfully lateralizes unilateral aldosterone producing adenomas (APA) in individuals with equivocal adrenal venous sampling results. In Progress in Primary Aldosteronism 5, July 3-4, 2017, Munich, Germany (Abstract)
  • 22 Hahner S, Stuermer A, Kreissl M, Reiners C, Fassnacht M, Haenscheid H, Beuschlein F, Zink M, Lang K, Allolio B, Schirbel A. 123 I-Iodometomidate for molecular imaging of adrenocortical cytochrome P450 family 11B enzymes. J Clin Endocrinol Metab 2008; 93: 2358-2365
  • 23 Hahner S, Sundin A. Metomidate-based imaging of adrenal masses. Horm Cancer 2011; 2: 348-353
  • 24 Hahner S, Kreissl MC, Fassnacht M, Haenscheid H, Bock S, Verburg FA, Knoedler P, Lang K, Reiners C, Buck AK, Allolio B, Schirbel A. Functional characterization of adrenal lesions using 123I-IMTO-SPECT/CT. J Clin Endocrinol Metab 2013; 98: 1508-1518
  • 25 Wadsak W, Mitterhauser M, Rendl G, Schuetz M, Mien LK, Ettlinger DE, Dudczak R, Kletter K, Karanikas G. 18F-FETO for adrenocortical PET imaging: a pilot study in healthy volunteers. Eur J Nucl Med Mol Imaging 2006; 33: 669-672
  • 26 Abe T, Naruse M, Young Jr WF, Kobashi N, Doi Y, Izawa A, Akama K, Okumura Y, Ikenaga M, Kimura H, Saji H, Mukai K, Matsumoto H. A novel CYP11B2-specific imaging agent for detection of unilateral subtypes of primary aldosteronism. J Clin Endocrinol Metab 2016; 101: 1008-1015
  • 27 Powsner RA, Palmer MR, Powsner ER. APPENDIX B. Major dosimetry for common radiopharmaceuticals. Essentials of nuclear medicine physics and instrumentation. Third Edition New York: John Wiley & Sons, Ltd.; 2013
  • 28 Bluemel C, Hahner S, Heinze B, Fassnacht M, Kroiss M, Bley TA, Wester HJ, Kropf S, Lapa C, Schirbel A, Buck AK, Herrmann K. Investigating the Chemokine Receptor 4 as Potential Theranostic Target in Adrenocortical Cancer Patients. Clin Nucl Med 2017; 42: e29-e34
  • 29 Hahner S. CXCR4 functional imaging in PA. In Progress in Primary Aldosteronism 5, July 3-4, 2017, Munich, Germany