A Rare Aldosterone-Producing Adenoma Detected by 68Ga-pentixafor PET-CT: A Case Report and Literature Review

Abstract

Context: Primary aldosteronism represents an important and common cause of hypertension and is characterized by autonomous aldosterone secretion that results in severe hypertension and hypokalemia. Nonetheless, its manifestations are atypical in some cases, which renders its diagnosis difficult. Case Description: Presented in this report is a Chinese female patient with blood pressure in the high-normal range, and her parathyroid hormone was significantly elevated. Elevated plasma aldosterone concentration plus suppressed plasma rennin activity was suggestive of primary aldosteronism. ⁶⁸Ga-pentixafor positron emission tomography/computed tomography revealed an aldosterone-producing adenoma, which was globally the second of its kind ever reported so far. Moreover, the tumor was located in an extremely rare area. Conclusions: Patients with primary aldosteronism may present with normal or high-normal blood pressure and a significantly elevated parathyroid hormone. ⁶⁸Ga-pentixafor PET/CT is potentially a helpful tool for the non-invasive characterization of patients with primary aldosteronism.

Keywords: 68Ga-pentixafor PET-CT; aldosterone-producing adenomas; blood pressure; parathyroid hormone; rare area.

Figure 1

(A) CT scan revealed a 21 × 13 mm low-density mass (about 9 HU). The enhanced adrenal gland CT revealed a significant enhancement of the mass (about 70 HU). (B,C) ⁶⁸Ga-pentixafor PET/CT revealed that the maximum standardized uptake was 22.83.

Figure 2

Gross pathological, histological and immunohistochemical findings. (a) Gross pathology revealed a 61 × 27 × 8 mm golden-yellow adenoma, which was connected to the right adrenal gland. (b) Hematoxylin-eosin staining, C: Normal adrenal cortex, M: Adrenal medulla; APA: Aldosterone-producing adenoma. (c) Immunohistochemical staining with CYP11B2.