PURPOSE OF REVIEW: Primary aldosteronism is increasingly recognized as a common secondary cause of hypertension. Successful demonstration of a unilateral cause (e.g. a classical 'Conn's adenoma') offers the potential for curative adrenalectomy. Adrenal vein sampling (AVS), in conjunction with cross-sectional imaging, remains the 'gold standard' for distinguishing unilateral and bilateral disease, but is technically demanding and frequently unsuccessful or inconclusive. As such, alternative strategies for lateralization, including nuclear medicine techniques, are being developed and brought into clinical practice. RECENT FINDINGS: Metomidate, a potent ligand of CYP11B1 and CYP11B2, can be C11H3-labelled as a PET tracer and has been shown to offer a rapid noninvasive alternative to AVS for localizing unilateral aldosterone-producing adenomas. SUMMARY: Increasing experience with 11C-metomidate PET-CT supports its use as an adjunct to AVS when this has failed, is ambiguous, or cannot be undertaken.A.S.P. and M.G. are supported by the National Institute
for Health Research Cambridge Biomedical Research
Centre. M.J.B. is a National Institute of Health Research
Senior Investigator.This is the final published version. It first appeared at http://journals.lww.com/co-endocrinology/Fulltext/2015/06000/Nuclear_imaging_in_the_diagnosis_of_primary.3.aspx
