What is the role of scintigraphy in the workup of hyperaldosteronism?

Updated: Sep 08, 2020
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Answer

The interest in adrenal cortical scintigraphy has been renewed by the use of the new hybrid single photon emission tomography (SPET)/CT technology. Hybrid imaging permits correct localization of findings by incorporating anatomical and functional information.

The NP-59 (6b-131) iodomethyl-19-norcholesterol scan, performed with dexamethasone suppression, was a helpful diagnostic tool in the detection and lateralization of PA. SPET/CT can identify small adenomas (0.8-1.5 cm) even in patients with chronic renal disease where the biochemical diagnosis of PA is difficult. A study by Di Martino et al suggested that NP-59 testing can be used to localize primary hyperaldosteronism preoperatively when there are contraindications to adrenal venous sampling or the results of sampling are inconclusive. Basing the NP-59 test value on pathologic outcomes resulted in a sensitivity and positive predictive value of 90.9% and 83.3%, respectively. Basing the test’s performance on postoperative blood pressure control resulted in a 91.6% value for both sensitivity and positive predictive value. [46]

Lately, 11C-metomidate PET-CT with and without dexamethasone suppression has been found to be a sensitive and specific noninvasive alternative to AVS. [47]  A literature review by Chen Cardenas et al indicated that as a PET-scan tracer, 11C-metomidate provides a potentially useful means of identifying PA and detecting adrenocortical masses. The investigators found it to be highly specific for adrenocortical tissue and to correlate with enzyme activity. [48]


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