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At least 145 records · Page 8Linked to original sources
PubMed1981

Adrenal scintigraphy in primary aldosteronism. Improved visualization after long-term pre-treatment with dexamethasone.

Dexamethasone-modified adrenal scintigrams were performed on 13 patients with an aldosterone-producing adenoma and on one patient with an aldosterone-producing carcinoma. Adrenal scintigrams using 131I-19-Iodocholesterol were obtained after short pre-treatment with dexamethasone, while 131I-6 beta-Iodomethyl-19-Nor-Cholesterol scintigrams were performed after long-term pre-treatment with dexamethasone during 9-21 days. Using the former procedure the adrenal scintigrams correctly identified the adenoma in 3 of 8 patients, while with the latter procedure the adrenal scintigrams localized the adenomas in 8 out of 9 patients, including 3 patients in whom the former procedure had failed. The adrenal carcinoma was not visualized with 131I-6 beta-Iodomethyl-19-Nor-Cholesterol. Thus, the sensitivity of 131I-19-Iodocholesterol scintigrams to detect aldosterone-producing adenomas was only 37.5%. Uptake of radioactivity in the normal contralateral adrenal gland accounted for the low detection rate. On the other hand, the 131I-6 beta-Iodomethyl-19-Nor-Cholesterol scintigrams, performed after long-term pre-treatment with dexamethasone, had a sensitivity of 89%. It is suggested that long-term pre-treatment with dexamethasone contributed to the improved sensitivity by a more effective suppression of radioactivity uptake in the normal adrenal gland.

19-Iodocholesterol↗
PubMed1980

[Clinical study of adrenal imaging with 123I-labeled-6 beta-iodomethyl-19-norcholesterol (author's transl)].

Although adrenal scintigraphy with 131I-6 beta-iodomethyl-19-norcholesterol (NCL-6-131I) was used for the first noninvasive imaging of the adrenal glands, it has the disadvantages. These are: (i) relatively high radiation dose to patients, (ii) the long time required for completion of the scan. To solve these problems, 123I-labeled 6 beta-iodomethyl-19-norcholesterol (NCL-6-123I) was synthesized and was used for adrenal scintigraphy in 6 cases. Successful images were obtained with 185 MBq (5 mCi)-260 MBq (7 mCi) of NCL-6-123I, and optimal time required for the satisfactory scan was 2-3 days after the administration. The estimate radiation dose was reduced by using 185 MBq (5 mCi) of NCL-6-123I instead of 18.5 MBq (0.5 mCi) of NCL-6-131I. From the result of this clinical study, NCL-6-123I was preferred for the adrenal scintigraphy.

Adosterol↗
PubMed1980

Failure to visualize adrenal glands in a patient with bilateral adrenal hyperplasia.

A patient with clinical and biochemical evidence of Cushing's disease and severe hyperlipidemia underwent an adrenal imaging procedure with NP-59 (6 beta-[131I]iodomethyl-19-norcholesterol), without visualization of either gland. Correction of the hyperlipidemia followed by repeated adrenal imaging resulted in bilateral visualization. A pituitary tumor was removed at surgery, confirming the diagnosis of Cushing's disease.

Adosterol↗
PubMed1980

The relationship of serum lipids to adrenal-gland uptake of 6 beta-[131I]iodomethyl-19-norcholesterol in Cushing's syndrome.

An alteration in serum cholesterol levels has been suggested as a possible modifier of adrenal uptake of the cholesterol analog, 6 beta-[131I]iodomethyl-19-norcholesterol (NP-59). To assess the effect of hypercholesterolemia upon NP-59 adrenal uptake, patients with Cushing's syndrome (eight with pituitary-dependent, four with ACTH-independent, and two with ectopic-ACTH syndrome) were selected for retrospective analysis based on the availability of serum cholesterol (n = 14) and triglyceride (n = 10) concentrations obtained at the time of adrenal scintigraphy. A negative correlation (r = 0.78, p < 0.01) was found between NP-59 uptake and serum cholesterol levels in patients with pituitary-dependent Cushing's disease. Compared with pituitary-dependent disease, the ectopic-ACTH syndrome and ACTH-independent states demonstrated equal or greater adrenal uptake of NP-59 at similar serum cholesterol concentrations. Serum triglyceride concentrations did not correlate with total adrenal uptake of NP-59 in any of the patient groups studied. Increased serum cholesterol concentrations are associated with diminished adrenal uptake of NP-59, and in some cases may limit the diagnostic efficacy of adrenal scintigraphy in Cushing's syndrome.

Adosterol↗
PubMed1995

[Nuclear medicine methods for the diagnosis of adrenal tumors].

Adrenal scintigraphy using 131I-6-beta-iodomethyl-19-norcholesterol or 6-methyl-75Se-methyl-19-norcholesterol is a function-dependent imaging method which, in association with high-resolution spatial imaging techniques, plays an essential role in the study of adrenocortical hyperfunction. It can distinguish between bilateral cortical hyperplasia and monolateral adenoma or carcinoma and can lateralise the adenoma. In patients with Cushing syndrome, in addition to allowing a distinction to be made between ACTH-dependent forms and independent forms, adrenocortical scintigraphy is particularly appropriate to identify non-common forms of adenomatous hyperplasia. Adrenocortical scintigraphy, performed during dexamethasone administration, is an accurate mean of differentiating bilateral adrenal hyperplasia from monolateral forms (adenoma or carcinoma) in patients with Conn's syndrome. Owing to the gradual spread of high-resolution spatial imaging techniques, the problem of the diagnostic classification of so-called "incidentalomas" (clinically silent masses discovered by chance) is a subject of considerable interest. Adreno-cortical scintigraphy appears to be able to provide an important contribution to identifying the functional behaviour of these tumours. Since the early 80s meta-iodobenzyl-guanidine (MIBG), marked with 131I or 123I, with a structure similar to norepinephrine and characterized by selective tropism for sympathetic and chromaffin tissue, has been used for the scintigraphic study of adrenal medulla. MIBG scintigraphy has been found to be particularly appropriate for the study of intra- and extra-adrenal, single and multiple, benign and malignant pheochromocytomas. This method has a high overall sensitivity and specificity. Lastly, MIBG scintigraphy is useful in the study of neuroblastoma.

3-Iodobenzylguanidine↗
PubMed1994

Scintigraphic evaluation of clinically silent adrenal masses.

UNLABELLED: We studied 229 patients with abnormal adrenal anatomy depicted by CT who were without biochemical evidence of endocrine dysfunction using the presence of 131I-6 beta-iodomethyl-nor-cholesterol (NP-59) adrenal gland uptake as an index of differential adrenal function in the evaluation of the clinically "silent" adrenal mass lesion. METHODS: NP-59 (1 mCi) was injected intravenously with posterior and lateral abdominal images obtained 5-7 days postinjection. RESULTS: One-hundred and fifty-nine of 185 patients with unilateral adrenal enlargement on CT had scintigraphic evidence that the mass represented a functioning (NP-59 avid) but not hypersecretory, (biochemically normal) adrenal cortical adenoma (concordant imaging pattern). Forty-one of 44 patients with intra-adrenal neoplasms were depicted on scintigraphy as decreased or absent NP-59 accumulation on the side of the adrenal mass (discordant imaging pattern). In this study, sensitivity was 71% (41 of 58 patients; 95% confidence interval (CI), 58% to 88%); specificity was 100% (171 of 171 patients; 95% CI, 95% to 100%) and accuracy was 93% (212 of 229 patients; 95% CI, 88% to 96%). CONCLUSIONS: These data confirm our earlier observations that the functional information depicted by scintigraphy complements the morphological evaluation by CT and in the absence of hormonal dysfunction, the presence of concordant CT and 131I-NP-59 scans are characteristic of functioning, but not hypersecretory, benign adrenocortical adenomas. Conversely, discordant CT and 131I-NP-59 scans are suggestive of nonfunctioning, space-occupying, adrenal lesions.

Adenoma↗
PubMed1993

Practical considerations in the scintigraphic evaluation of endocrine hypertension. The adrenal cortex and medulla.

A nuclear scan maps the distribution of a radiopharmaceutical that is specific for a physiologic property of a targeted tissue. As such, it is not limited by the anatomic changes necessary for CT and MR scans. It is just because of this that maps of specific metabolic precursors of adrenal medullary and cortical hormones offer information crucial to the therapeutic strategy of endocrine hypertension. NP-59 and MIBG scans can specify the nature of abnormalities revealed by anatomic images and because of the ease of surveying the whole body can give transcendent information about lesions remote from the adrenals. In instances when the origin of endocrine hypertension is not forthcoming from CT or MR imaging or when the anatomic and biochemical findings are in conflict, NP-59 or MIBG can almost always provide the answer.

3-Iodobenzylguanidine↗
PubMed1996

Simultaneous scintigraphic depiction of aldosteronoma and adrenal infarction.

Primary aldosteronism is a potentially curable cause of hypertension, especially when caused by an adrenal adenoma. Aldosteronomas because of their small size often elude techniques to locate them. This case illustrates the advantages, disadvantages and complications of noninvasive techniques used for their diagnosis. A patient with hypertension and hypokalemia underwent an adrenal venous effluent sampling for measurement of aldosterone concentrations. This procedure was complicated by an injury to the right adrenal gland. Subsequently, it was difficult to control the patient's hypertension and hypokalemia with medical therapy alone. A re-assessment years after his initial diagnosis included a CT scan, which now visualized a left adrenal tumor. The functional status of this tumor and lack of function of the previously injured right adrenal gland were demonstrated by NP-59 scintigraphy. This information modified the surgical intervention (adenectomy rather than total adrenalectomy) and the residual left sided adrenal tissue prevented adrenocortical insufficiency. A year later the patient remains euadrenal.

Adosterol↗
PubMed1997

Scintigraphic assessment of therapeutic success in aldosteronomas treated by transcatheter arterial embolization using absolute ethanol.

UNLABELLED: Adrenocortical scintigraphy was examined as an indicator of therapeutic success in aldosteronomas treated by transcatheter arterial embolization (TAE) with absolute ethanol (AE). METHODS: Adrenocortical scintigraphy was performed 7 days after intravenous injection of 37 MBq 131I-6-beta-iodomethyl-19-norcholesterol before and after TAE. Complete or incomplete therapeutic success was determined by periodic measurements of the levels of plasma aldosterone and correlated with the scintigraphic results. RESULTS: The aldosteronoma was visualized as a hot nodule in nine patients and a warm nodule in one patient before TAE. Scintigraphy showed a hot, residual hot or warm nodule on seven occasions (six occasions after the first TAE and one occasion after the second TAE) when the techniques were incompletely successful and disappearance on seven occasions when success was achieved (three occasions after the first TAE and one occasion after the second TAE). Of the seven occasions when TAE was unsuccessful, four patients received the second or third TAE to result in complete destruction of the aldosteronoma; three patients underwent unilateral adrenalectomy. CONCLUSION: Adrenocortical scintigraphy can correctly predict the effect of TAE on aldosteronomas and is a valuable indicator for decisions on the necessity of repeated TAE or adrenalectomy.

Adosterol↗
PubMed1998

Diagnostic evaluation of the adrenal incidentaloma: decision and cost-effectiveness analyses.

UNLABELLED: The goal of this study was to examine the clinical and economic outcomes of alternative diagnostic strategies for differentiating benign from malignant adrenal masses. METHODS: We used cost-effectiveness assessment derived from decision analysis and the economic perspective of the payer of health care services. One-time evaluation with fine-needle aspiration (FNA) and combinations of chemical-shift MRI, noncontrast CT, 131I-6beta-iodomethylnorcholesterol (NP-59) scintigraphy, with or without FNA, in a hypothetical cohort of 1000 patients with incidentally discovered unilateral, nonhypersecretory adrenal masses. We calculated and compared the diagnostic effectiveness, costs and cost-effectiveness of the alternative strategies based on estimates from published literature and institutional charge data. RESULTS: At an assumed baseline malignancy rate of 0.25, diagnostic utility varied from 0.31 (CT0) to 0.965 (NP-59) and diagnostic accuracy from 0.655 [noncontrast CT using a cut-off attenuation value of > or = 0 (CT0)] to 0.983 (NP-59). The average cost per patient per strategy ranged from $746 (NP-59) to $1745 (MRI +/- FNA). The best and worst potential cost-to-diagnostic utility ratios were 773 (NP-59) and 2839 (CT0) and 759 (NP-59) and 1982 (MRI +/- FNA) for cost and diagnostic accuracy, respectively. The NP-59 strategy was the optimal choice regardless of the expected outcome examined: cost, diagnostic utility, diagnostic accuracy or cost-effectiveness. Varying the prevalence of malignancy did not alter the cost-effectiveness advantage of NP-59 over the other diagnostic modalities. CONCLUSION: Based on available estimates of reimbursement costs and diagnostic test performance and using reasonable clinical assumptions, our results indicate that the NP-59 strategy is the most cost-effective diagnostic tool for evaluating adrenal incidentalomas over a wide range of malignancy rates and that additional clinical studies are warranted to confirm this cost-effectiveness advantage.

Adosterol↗