SFEBES2016 Featured Clinical Cases Featured Clinical Cases (10 abstracts)
Successful treatment of primary aldosteronism with partial adrenalectomy, facilitated by the use of 11C-Metomidate PET/CT
Waiel Bashari 1 , Andrew Powlson 1 , Olympia Koulouri 1 , Denis Quill 2 , Morris Brown 1 , Heok Cheow 1 , Michael Conall Dennedy 2 & Mark Gurnell 1
1Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; 2National University of Ireland & Galway University Hospital, Galway, Ireland.
Background: Primary aldosteronism (PA) is responsible for 5-10% of all cases of HTN. The current gold standard test for determining the side of aldosterone hypersecretion is adrenal vein sampling (AVS). 11C-Metomidate PET/CT (METO-PET) has recently emerged as a potential non-invasive alternative to AVS. As 11C-Metomidate is concentrated within ‘hyperfunctioning’ nodules, METO-PET potentially not only identifies the side, but the exact site of aldosterone hypersecretion, thus allowing more targeted surgical intervention.
Case report: A 45-year-old man was found to have HTN and hypokalaemia after sustaining a myocardial infarction. He required four anti-hypertensive agents to achieve BP control. His aldosterone was elevated with a suppressed renin, and aldosterone did not adequately decrease following saline suppression, confirming the diagnosis of PA. Adrenal CT and MRI did not convincingly show a lesion. He underwent AVS, but the result was inconclusive (right adrenal vein not cannulated). METO-PET revealed increased tracer uptake in a subcentimeter nodule on the left adrenal (Figure 1).
Treatment: He underwent a posterior retroperitoneoscopic procedure, during which the lateral limb of the left adrenal was removed, leaving the rest of the gland in situ. Histology confirmed the presence of a small Conn’s adenoma. The patient is normotensive post-surgery, on no antihypertensive medications, with normal biochemistry.
Conclusion: This case highlights the ability of METO-PET to not only lateralize, but actually localize the site of aldosterone hypersecretion. This allows selective removal of a Conn’s adenoma with sparing of the adjacent normal adrenal gland.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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