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11C-metomidate PET-CT scanning can identify aldosterone-producing adenomas after unsuccessful lateralisation with CT/MRI and adrenal venous sampling

Journal of Human Hypertension volume 31, pages 483–484 (2017)Cite this article

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Primary hyperaldosteronism, characterised by hypertension and hypokalaemia, is a syndrome caused by aldosterone excess most commonly from either a unilateral aldosterone-producing adenoma or bilateral adrenal hyperplasia. Subtype classification can be challenging with cross-sectional imaging and even with interventional radiological techniques such as adrenal venous sampling. Imaging with 11 C-metomidate positron emission tomography-computed tomography (PET-CT) is an emerging tool that facilitates functional characterisation and potentially successful surgical intervention of aldosterone-producing adenomas. This technique has highlighted that, although unilateral adenomas and bilateral hyperplasia represent opposite ends of the disease spectrum, a relatively common intermediate phenotype exists of unilateral/bilateral multinodular disease.

A 44-year-old female presented to a tertiary endocrine clinic with a blood pressure of 188/114 mm Hg, managed with several antihypertensive drugs including spironolactone 50 mg o.d. (once daily), having been previously investigated for secondary hypertension. Biochemically, her baseline investigations were consistent with primary hyperaldosteronism with an aldosterone:renin ratio of 2125 prior to drug treatment. A high-resolution adrenal CT scan had suggested a bulky left adrenal gland and possible right adrenal nodule; however, subsequent adrenal magnetic resonance imaging reported normal adrenal glands bilaterally. Adrenal venous sampling (AVS) was attempted on two occasions, but was technically unsuccessful. Thus, in the absence of an exact subtype of primary aldosteronism (PA), medical management with mineralocorticoid receptor antagonists was preferred with spironolactone titrated up to 100 mg b.d. (twice daily). The patient was intolerant of medication and sought referral to a supraregional neuroendocrine tumour multidisciplinary team.

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Authors and Affiliations

  1. Neuroendocrine Tumour Group, University Hospital Aintree, Liverpool, UK

    J Ouyang & D J Cuthbertson

  2. Department of General Surgery, University Hospital Aintree, Liverpool, UK

    R Hardy

  3. William Harvey Research Institute, Queen Mary University London, London, UK

    M Brown

  4. Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, UK

    T Helliwell

  5. Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK

    M Gurnell

  6. National Institute for Health Research, Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK

    M Gurnell

Authors
  1. J Ouyang
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  2. R Hardy
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  3. M Brown
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  4. T Helliwell
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  5. M Gurnell
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  6. D J Cuthbertson
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Correspondence to D J Cuthbertson.

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Ouyang, J., Hardy, R., Brown, M. et al. 11C-metomidate PET-CT scanning can identify aldosterone-producing adenomas after unsuccessful lateralisation with CT/MRI and adrenal venous sampling. J Hum Hypertens 31, 483–484 (2017). https://doi.org/10.1038/jhh.2017.9

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