PURPOSE: Primary aldosteronism (PA), characterized by an excessive production of aldosterone, affects 5-13 % of patients with hypertension. Accurate strategies are needed for the timely diagnosis of PA to allow curability and prevention of excessive cardiovascular events and related damage. This study aimed to evaluate the usefulness of semiquantification of (131)I-6β-iodomethyl-norcholesterol (NP-59) single photon emission computed tomography (SPECT)/CT in differentiating aldosterone-producing adenoma (APA) from idiopathic adrenal hyperplasia (IAH) and in predicting clinical outcomes after adrenalectomy. METHODS: We retrospectively reviewed 49 PA patients who had undergone adrenalectomy after NP-59 SPECT/CT within 1 year. A conventional visual scale (VS) and two semiquantitative parameters generated from SPECT/CT, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON), with cutoff values calculated by receiver-operating characteristic (ROC) analysis, were compared with pathology results and postsurgical outcomes to determine the accuracy. RESULTS: An ALR cutoff of 1.84 and a CON cutoff of 1.15 showed an ability to distinguish adenoma from hyperplasia similar to VS (p = 0.2592 and 0.1908, respectively). An ALR cutoff of 2.28 and a CON cutoff of 1.11 yielded the highest sensitivity and specificity to predict postsurgical outcomes, and an ALR of 2.28 had an ability superior to VS (p = 0.0215), while a CON of 1.11 did not (p = 0.1015). Patients with either ALR or CON greater than the cutoff had a high probability of positive postsurgical outcomes (n = 36/38), while patients with both ALR and CON less than the cutoff had a low probability of positive postsurgical outcomes (n = 2/11). CONCLUSION: Semiquantification of NP-59 scintigraphy has an ability similar to VS in differentiating APA from IAH, but an excellent ability to predict postsurgical outcomes of adrenalectomy. An ALR or CON greater than the cutoff strongly suggests benefits from adrenalectomy, and both ALR and CON less than the cutoff implies a reduced chance of improvement in postsurgical outcome.
PURPOSE: Primary aldosteronism (PA), characterized by an excessive production of aldosterone, affects 5-13 % of patients with hypertension. Accurate strategies are needed for the timely diagnosis of PA to allow curability and prevention of excessive cardiovascular events and related damage. This study aimed to evaluate the usefulness of semiquantification of (131)I-6β-iodomethyl-norcholesterol (NP-59) single photon emission computed tomography (SPECT)/CT in differentiating aldosterone-producing adenoma (APA) from idiopathic adrenal hyperplasia (IAH) and in predicting clinical outcomes after adrenalectomy. METHODS: We retrospectively reviewed 49 PA patients who had undergone adrenalectomy after NP-59 SPECT/CT within 1 year. A conventional visual scale (VS) and two semiquantitative parameters generated from SPECT/CT, adrenal to liver ratio (ALR) and lesion to contralateral ratio of bilateral adrenal glands (CON), with cutoff values calculated by receiver-operating characteristic (ROC) analysis, were compared with pathology results and postsurgical outcomes to determine the accuracy. RESULTS: An ALR cutoff of 1.84 and a CON cutoff of 1.15 showed an ability to distinguish adenoma from hyperplasia similar to VS (p = 0.2592 and 0.1908, respectively). An ALR cutoff of 2.28 and a CON cutoff of 1.11 yielded the highest sensitivity and specificity to predict postsurgical outcomes, and an ALR of 2.28 had an ability superior to VS (p = 0.0215), while a CON of 1.11 did not (p = 0.1015). Patients with either ALR or CON greater than the cutoff had a high probability of positive postsurgical outcomes (n = 36/38), while patients with both ALR and CON less than the cutoff had a low probability of positive postsurgical outcomes (n = 2/11). CONCLUSION: Semiquantification of NP-59 scintigraphy has an ability similar to VS in differentiating APA from IAH, but an excellent ability to predict postsurgical outcomes of adrenalectomy. An ALR or CON greater than the cutoff strongly suggests benefits from adrenalectomy, and both ALR and CON less than the cutoff implies a reduced chance of improvement in postsurgical outcome.
Authors: Gian Paolo Rossi; Marlena Barisa; Bruno Allolio; Richard J Auchus; Laurence Amar; Debbie Cohen; Christoph Degenhart; Jaap Deinum; Evelyn Fischer; Richard Gordon; Ralph Kickuth; Gregory Kline; Andre Lacroix; Steven Magill; Diego Miotto; Mitsuhide Naruse; Tetsuo Nishikawa; Masao Omura; Eduardo Pimenta; Pierre-François Plouin; Marcus Quinkler; Martin Reincke; Ermanno Rossi; Lars Christian Rump; Fumitoshi Satoh; Leo Schultze Kool; Teresa Maria Seccia; Michael Stowasser; Akiyo Tanabe; Scott Trerotola; Oliver Vonend; Jiri Widimsky; Kwan-Dun Wu; Vin-Cent Wu; Achille Cesare Pessina Journal: J Clin Endocrinol Metab Date: 2012-03-07 Impact factor: 5.958
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Authors: C A Proye; E A Mulliez; B M Carnaille; M Lecomte-Houcke; M Decoulx; J L Wémeau; J Lefebvre; A Racadot; O Ernst; D Huglo; A Carré Journal: Surgery Date: 1998-12 Impact factor: 3.982
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Authors: Iosif A Mendichovszky; Andrew S Powlson; Roido Manavaki; Franklin I Aigbirhio; Heok Cheow; John R Buscombe; Mark Gurnell; Fiona J Gilbert Journal: Diagnostics (Basel) Date: 2016-11-18
Authors: Chia-Hui Chang; Stephen Shei-Dei Yang; Yao-Chou Tsai; Shi-Wen Kuo; Shiou-Chi Cherng; Ching-Chu Lu; Ruoh-Fang Yen; Vin-Cent Wu; Ya-Hui Hu Journal: Ci Ji Yi Xue Za Zhi Date: 2018 Jul-Sep