Abstract
Objective
To describe clinical practice experience of 11C‐Metomidate PET/CT as an adjunct to adrenal vein sampling (AVS) in the lateralization of aldosterone producing adenomas (APA) in primary aldosteronism (PA).
Context
Accurate lateralisation of aldosterone producing adenomas in the setting of primary aldosteronism (PA) offers the potential for surgical cure and improved long‐term cardiovascular outcomes. Challenges associated with adrenal vein sampling, the current gold‐standard lateralization modality, mean that only a small proportion of potentially eligible patients currently make it through to surgery. This has prompted consideration of alternative strategies for lateralisation, including the application of novel molecular PET tracers such as 11C‐Metomidate.
Design
Clinical Service Evaluation / Retrospective audit.
Patients
Fifteen individuals with a confirmed diagnosis of PA, undergoing lateralization with 11C Metomidate PET/CT prior to final clinical decision on surgical versus medical management.
Measurements
All patients underwent screening aldosterone renin ratio (ARR), followed by confirmatory testing with the seated saline infusion test, according to Endocrine Society Clinical Practice Guidelines. Adrenal glands were imaged using dedicated adrenal CT. 11C‐Metomidate PET/CT was undertaken due to equivocal or failed AVS. Management outcomes were assessed by longitudinal measurement of blood pressure, ARR, number of hypertensive medications following adrenalectomy or institution of medical therapy.
Results
We describe the individual lateralisation and clinical outcomes for 15 patients with PA.
Conclusion
11C‐Metomidate PET/CT in conjunction with adrenal CT and AVS provided useful information which aided clinical decision making for PA within a multidisciplinary hypertension clinic.
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