A1 Refereed original research article in a scientific journal
Functional imaging with C-11-metomidate PET for subtype diagnosis in primary aldosteronism
Authors: Minna Soinio, Anna-Kaarina Luukkonen, Marko Seppänen, Jukka Kemppainen, Janne Seppänen, Juha-Pekka Pienimäki, Helena Leijon , Tiina Vesterinen, Johanna Arola, Eila Lantto, Semi Helin, Ilkka Tikkanen, Saara Metso, Tuomas Mirtti, Ilkka Heiskanen, Leena Norvio, Mirja Tiikkainen, Tuula Tikkanen, Timo Sane, Matti Välimäki, Celso E Gomez-Sanchez, Ilkka Pörsti, Pirjo Nuutila, Pasi I Nevalainen, Niina Matikainen
Publisher: BIOSCIENTIFICA LTD
Publication year: 2020
Journal: European Journal of Endocrinology
Journal name in source: EUROPEAN JOURNAL OF ENDOCRINOLOGY
Journal acronym: EUR J ENDOCRINOL
Volume: 183
Issue: 6
First page : 539
Last page: 550
Number of pages: 12
ISSN: 0804-4643
eISSN: 1479-683X
DOI: https://doi.org/10.1530/EJE-20-0532
Self-archived copy’s web address: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045447/
Objective: Endocrine Society guidelines recommend adrenal venous samplin g (AVS) in primary aldosteronism (PA) if adrenalectomy is considered. We tested whether functional imagi ng of adrenal cortex with C-11-metomidate (C-11-MTO) could offer a noninvasive alternative to AVS in the subtype clas sification of PA.Design: We prospectively recruited 58 patients with confirmed PA who w ere eligible for adrenal surgery.Methods: Subjects underwent AVS and C-11- MTO-PET without dexamethasone pretreatment in random order. The lateralization of C-11-MTO-PET and adrenal CT were compared with AVS in all subjects and in a prespecified adrenalectomy subgroup in which the diagnosis was confirmed with immunohistochemical staining for CYP11B2.Results: In the whole study population, the concordance of AVS and C-11-MTO-PET was 51% and did not differ from that of AVS and adrenal CT (53%). The concordance of AVS and C-11-MTO-PET was 55% in unilateral and 44% in bilateral PA. In receiver operating characteristics analysis, the maximum sta ndardized uptake value ratio of 1.16 in C-11-MTO-PET had an AUC of 0.507 (P = n.s.) to predict allocation to adrenalectomy or medical therapy with sensitivity of 55% and specificity of 44%. In the prespecified adrenalectomy subgroup, A VS and C-11-MTO-PET were concordant in 10 of 19 subjects with CYP11B2-positive adenoma and in 6 of 10 with CYP11B2-positivity without an adenoma.Conclusions: The concordance of C-11-MTO-PET with AVS was clinically suboptimal, and did not outpe rform adrenal CT. In a subgroup with CYP11B2-positive adenoma, C-11-MTO- PET identified 53% of cases. C-11-MTO-PET appeared to be inferior to AVS for subtype classification of PA.
