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Randomized Controlled Trial
. 2025 Aug;52(10):3632-3642.
doi: 10.1007/s00259-025-07244-9. Epub 2025 Apr 4.

Total or partial adrenalectomy for aldosterone-producing adenoma: can 68Ga-Pentixafor PET/CT predict surgical outcomes?

Wen-Cai Zheng #  1   2 , Shao-Ming Chen #  3 , Qian-Renshun Qiu #  1   2 , Xiao-Dong Li #  1   2 , Fei Lin  1   2 , Xi-Mei Shen  4 , Zhou-Fei Fang  5   6   7   8 , Yu-Ting Xue  1   2 , Bin Lin  1   2 , Xiong-Lin Sun  1   2 , Qing-Shui Zheng  1   2 , Yong Wei  1   2 , Yong-Ping Lin  9 , Hao Xiong  10 , Xue-Yi Xue  11   12   13 , Zhi-Bin Ke  14   15 , Ning Xu  16   17   18
Affiliations
Randomized Controlled Trial

Total or partial adrenalectomy for aldosterone-producing adenoma: can 68Ga-Pentixafor PET/CT predict surgical outcomes?

Wen-Cai Zheng et al. Eur J Nucl Med Mol Imaging. 2025 Aug.

Abstract

Objective: This study aimed to compare the accuracy of adrenal vein sampling (AVS) and 68Ga-Pentixafor positron emission tomography (PET)/computed tomography (CT) in predicting the functional outcome from adrenalectomy in patients with primary aldosteronism (PA), and to investigate the utility of 68Ga-Pentixafor PET/CT in laparoscopic partial adrenalectomy.

Methods: We prospectively enrolled patients diagnosed with PA. All patients underwent 68Ga-Pentixafor PET/CT and AVS. Patient management was discussed by a multidisciplinary team. Ninety surgically eligible patients were randomized to partial (n = 45) or total adrenalectomy (n = 45), while 97 received medical therapy. Postoperative Aldosterone Surgical Outcome (PASO) criteria served as the gold standard.

Results: In total, 187 patients with PA were examined using 68Ga-pentixafor PET/CT and AVS, and 90 patients who underwent surgery were included in the analysis. The accuracy of 68Ga-Pentixafor PET/CT in correctly predicting biomedical partial or complete success, biomedical complete success, clinical partial or complete success, and clinical complete success was 78.89%, 77.78%, 77.67%, and 67.78%, respectively. For AVS, the accuracies were 74.44%, 73.33%, 70.00%, and 54.44%, respectively. 68Ga-pentixafor PET/CT was not significantly superior, but the differences lay within the pre-specified - 10% margin for non-inferiority. Functional outcomes did not significantly differ between the partial and total adrenalectomy groups. Multivariable logistic analysis demonstrated that the lower highest systolic blood pressure and higher SUVmax were independent factors of complete clinical success. The AUC for SUVmax in determining clinical complete success was 0.896, with an optimal cutoff value of 9.8. Subgroup analysis showed no functional outcome difference between laparoscopic partial and total adrenalectomy for patients with an SUVmax over 9.8. However, for those with an SUVmax below 9.8, laparoscopic total adrenalectomy yielded better results than laparoscopic partial adrenalectomy.

Conclusion: The accuracy of 68Ga-Pentixafor PET/CT is comparable to the conventional, invasive method of AVS in forecasting the functional outcomes of adrenalectomy. SUVmax is an independent factor in determining complete clinical success and can potentially predict the functional outcome of laparoscopic adrenalectomy. It is suggested that laparoscopic partial adrenalectomy be performed on individuals who present an SUVmax value exceeding 9.8. The ability of 68Ga-Pentixafor PET/CT to localize aldosterone-producing adenoma ultimately paves the way for the use of more focal treatment options.

Trial registration: ChiCTR2300070830. Registered 23 April 2023.

Keywords: 68Ga-Pentixafor PET/CT; Adrenal vein sampling; Functional outcome; Laparoscopic partial adrenalectomy; Primary aldosteronism.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Human Research Ethics Committee of Fujian Medical University, and the informed consent was obtained from patients and volunteers. Consent for publication: Not applicable. Competing interests: All authors declare no conflict of interests.

References

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    1. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(5):1889–916.
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