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. 2022 Nov;5(6):e368.
doi: 10.1002/edm2.368. Epub 2022 Aug 29.

Lateralization in 11 C-Metomidate PET and outcome of adrenalectomy in primary aldosteronism

Juhani Isojärvi  1 , Marianna Viukari  1 , Ilkka Pörsti  2   3 , Helena Leijon  4 , Tiina Vesterinen  4 , Marko Seppänen  5   6 , Pasi I Nevalainen  3 , Niina Matikainen  1
Affiliations

Lateralization in 11 C-Metomidate PET and outcome of adrenalectomy in primary aldosteronism

Juhani Isojärvi et al. Endocrinol Diabetes Metab. 2022 Nov.

Abstract

Introduction: Subtype classification method is essential when considering adrenalectomy as a possible treatment for primary aldosteronism. We aimed to retrospectively evaluate surgical outcomes of primary aldosteronism in patients who had undergone 11 C-metomidate positron emission tomography (11 C-MTO-PET) for subtype classification.

Methods: Postoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative 11 C-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on 11 C-MTO-PET alone and those with concordant or discordant lateralization in 11 C-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure.

Results: Adrenalectomy side was based on 11 C-MTO-PET alone in 14 cases and on AVS in 30 cases of whom 42 achieved complete and two partial biochemical cures. Among those who underwent AVS and were operated according to it, the two lateralization methods were concordant in 22 cases and discordant in 8 cases. Similar immunohistochemical profiles and cure rates were seen after 11 C-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant 11 C-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with 11 C-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery.

Conclusions: Outcomes of adrenalectomy based on clinically significant lateralization in 11 C-MTO-PET alone correspond to those based on 11 C-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with 11 C-MTO-PET in case of discordant lateralization studies.

Keywords: 11C-Metomidate positron emission tomography; CYP11B2 immunostaining; adrenal venous sampling; primary aldosteronism; subtype classification in primary aldosteronism; surgical outcome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The subjects with an adrenalectomy sample who all underwent 11C‐MTO‐PET were divided into those with concordant and discordant 11C‐MTO‐PET metabolic activity side with respect to the adrenalectomy side. The concordant group was further divided into AVS‐guided and 11C‐MTO‐PET‐guided adrenalectomy groups. The clinical and biochemical outcomes are presented according to the histopathological diagnosis of either APA or non‐APA. 11C‐MTO‐PET, 11C‐metomidate positron emission tomography; APA, aldosterone‐producing adenoma. Clinical cure was not evaluated for one subject in the concordant group
See this image and copyright information in PMC

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