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

Primaarinen hyperaldosteronismi on sekundaarisen hypertension yleisin syy. Siihen liittyy essentiaalia hypertensiota korkeampi kuolleisuus ja komplikaatioriski. Adrenalektomia on lääkehoitoa tehokkaampi hoitomuoto, mutta se edellyttää preoperatiivisesti huolellista taudin alatyypin määritystä. Tässä suhteessa kultaisena standardina pidettyyn lisämunuaislaskimoiden katetrisaatiotutkimukseen (AVS) liittyy monia metodologisia ongelmia. Uutena mahdollisena menetelmänä on viime vuosina tutkittu vaihtelevin tuloksin 11C-metomidaattipositroniemissiotomografiaa (11C-MTO-PET). Tässä tutkimuksessa analysoimme retrospektiivisesti 44 potilasta, joilta lisämunuainen oli poistettu primaarisen hyperaldosteronismin vuoksi. Kaikille potilaille oli preoperatiivisesti tehty 11C-MTO-PET. Lisäksi 31 potilaalle oli tehty onnistuneesti AVS. Potilaat jaettiin tutkimusta varten kahteen alaryhmään: 36 potilaan konkordanssiryhmään, joilla 11C-MTO-PET:n ja AVS:n tulokset vastasivat toisiaan tai 11C-MTO-PET oli ainoa käytetty menetelmä, sekä 8 potilaan diskordanssiryhmään, joilla menetelmien tulokset olivat keskenään ristiriitaiset ja adrenalektomia tehtiin AVS:n perusteella. Konkordanssiryhmä jaettiin edelleen kahtia sen mukaan, kumman menetelmän perusteella adrenalektomia tehtiin. Näiden ryhmien postoperatiivista paranemista vertailtiin tilastollisessa analyysissa. Konkordanssi- ja diskordanssiryhmien biokemiallisessa ja kliinisessä paranemisessa ei havaittu tilastollisesti merkitsevää eroa. Myöskään konkordanssiryhmän sisällä ei ollut eroa paranemisessa 11C-MTO-PET:n ja AVS:n perusteella leikattujen välillä. Mikäli diskordanssiryhmässä alatyypin määritys olisi tehty 11C-MTO-PET:n perusteella, 6 potilasta olisi jätetty turhaan leikkaushoidon ulkopuolelle ja 2 potilaalta olisi leikattu väärä lisämunuainen. 11C-MTO-PET oli siis virheellinen kaikkiaan 18 %:ssa tapauksista. Vastaavasti AVS oli virheellinen vain 3 %:ssa tapauksista. Tutkimus osoittaa, että 11C-MTO-PET ja AVS johtavat samanlaisiin postoperatiivisiin paranemistuloksiin. Jos menetelmien tulokset ovat kuitenkin keskenään ristiriitaiset, vaikuttaisi AVS luotettavammalta alatyypin määrityksessä

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

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 C-11-metomidate positron emission tomography (C-11-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 C-11-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on C-11-MTO-PET alone and those with concordant or discordant lateralization in C-11-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure. Results Adrenalectomy side was based on C-11-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 C-11-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant C-11-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with C-11-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 C-11-MTO-PET alone correspond to those based on C-11-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with C-11-MTO-PET in case of discordant lateralization studies.Peer reviewe

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

IntroductionSubtype 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 11C-metomidate positron emission tomography (11C-MTO-PET) for subtype classification.MethodsPostoperative clinical and biochemical cure and histopathological diagnosis from biobank samples were retrospectively evaluated in 44 patients who had all undergone preoperative 11C-MTO-PET with or without adrenal venous sampling (AVS). We compared those operated based on 11C-MTO-PET alone and those with concordant or discordant lateralization in 11C-MTO-PET and AVS studies according to postoperative immunohistochemical findings and biochemical and clinical cure.ResultsAdrenalectomy side was based on 11C-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 11C-MTO-PET alone or AVS-based operations. Respectively, those with concordant or discordant 11C-MTO-PET and AVS lateralization did not differ in surgical outcome. Together, we found errors of lateralization diagnostics with 11C-MTO-PET in 18% and with AVS in 3% among those eligible for adrenal surgery.ConclusionsOutcomes of adrenalectomy based on clinically significant lateralization in 11C-MTO-PET alone correspond to those based on 11C-MTO-PET with concordant AVS lateralization. However, our results suggest that diagnosis of unilateral PA should be performed with caution with 11C-MTO-PET in case of discordant lateralization studies.</p