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Nuclear medicine imaging in the evaluation of endocrine hypertension.

Sharma P, Kumar R - Indian J Endocrinol Metab (2012)

Bottom Line: Common endocrine causes of hypertension include pheochromocytoma, Cushing's syndrome, primary hyperaldosteronism, and thyroid disorders.It has established role in patients of pheochromocytoma/paraganglioma, Cushing's syndrome, aldosteronism, and thyroid disorders.We present a brief overview of role of nuclear medicine imaging in endocrine hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Endocrine hypertension forms a small (< 5%) but curable subset of patients with hypertension. Common endocrine causes of hypertension include pheochromocytoma, Cushing's syndrome, primary hyperaldosteronism, and thyroid disorders. Nuclear medicine imaging plays an important role in evaluation of patients with endocrine hypertension. It has established role in patients of pheochromocytoma/paraganglioma, Cushing's syndrome, aldosteronism, and thyroid disorders. We present a brief overview of role of nuclear medicine imaging in endocrine hypertension. Development of newer radiotracers might further broaden the role of nuclear medicine in these patients.

No MeSH data available.


Related in: MedlinePlus

A 28-year-old male with MEN 2 syndrome. CT (a) images reveal bilateral large adrenal masses with necrotic centre (bold arrows). 68Ga-DOTANOC PET (b) and PET-CT (c) images show intense tracer uptake in peripheral part of the masses, with no uptake in central necrotic part. Maximum intensity projection (MIP) image show bilateral adrenal masses (arrows). The diagnosis of pheochromocytoma was made and confirmed with histopathology. Note should be made of other foci of uptake in bones (arrows) due to uptake of the tracer in bone metastasis from medullary carcinoma of thyroid
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Figure 3: A 28-year-old male with MEN 2 syndrome. CT (a) images reveal bilateral large adrenal masses with necrotic centre (bold arrows). 68Ga-DOTANOC PET (b) and PET-CT (c) images show intense tracer uptake in peripheral part of the masses, with no uptake in central necrotic part. Maximum intensity projection (MIP) image show bilateral adrenal masses (arrows). The diagnosis of pheochromocytoma was made and confirmed with histopathology. Note should be made of other foci of uptake in bones (arrows) due to uptake of the tracer in bone metastasis from medullary carcinoma of thyroid

Mentions: Somatostatin receptor imaging might be considered as a supplement for MIBG scintigraphy in pheochromocytoma and paragangliomas patients with suspected metastatic disease.[12] From in vitro and in vivo studies, it has been established that somatostatin receptor subtypes 3 and 4 are expressed in pheochromocytoma, including adrenal and metastatic disease.[19] In-111pentetreotide (Octreoscan; Mallinckrodt Inc.) has only moderate affinity for these subtypes, compared with subtypes 2 and 5, Somatostatin receptor scintigraphy (SRS) has been used with variable results to detect this tumor.[2021] It has higher sensitivity for detecting metastatic pheochromocytoma than for detecting benign pheochromocytoma.[22] Newer somatostatin analogues like 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid -Tyr3-octreotide (DOTATOC) have shown favourable characteristics in imaging with high affinity for somatostatin receptors and a stable and easy process of labelling.[23] Although most existing somatostatin-based tracers only have affinity for the somatostatin receptor subtype 2, which is not always present on pheochromocytoma and paraganglioma cells, newer compounds, such as 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid-1-NaI3-Octreotide (DOTANOC), also have affinity for other somatostatin receptor subtypes.[24] Kroiss et al. compared Ga-68 DOTANOC spositron emission tomography (PET)-CT with I-123MIBG scintigraphy in patients with pheochromocytoma.[25] In pheochromocytoma patients, on a per-lesion basis, the sensitivity of Ga-68DOTA-TOC was 91.7% and that of I-123MIBG was 63.3%. Our experience is similar, with Ga-68 DOTANOC/TOC being better than I-131 MIBG for detecting extra adrenal pheochromocytoma, smaller lesions and lesions with central necrosis [Figure 3].


Nuclear medicine imaging in the evaluation of endocrine hypertension.

Sharma P, Kumar R - Indian J Endocrinol Metab (2012)

A 28-year-old male with MEN 2 syndrome. CT (a) images reveal bilateral large adrenal masses with necrotic centre (bold arrows). 68Ga-DOTANOC PET (b) and PET-CT (c) images show intense tracer uptake in peripheral part of the masses, with no uptake in central necrotic part. Maximum intensity projection (MIP) image show bilateral adrenal masses (arrows). The diagnosis of pheochromocytoma was made and confirmed with histopathology. Note should be made of other foci of uptake in bones (arrows) due to uptake of the tracer in bone metastasis from medullary carcinoma of thyroid
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475893&req=5

Figure 3: A 28-year-old male with MEN 2 syndrome. CT (a) images reveal bilateral large adrenal masses with necrotic centre (bold arrows). 68Ga-DOTANOC PET (b) and PET-CT (c) images show intense tracer uptake in peripheral part of the masses, with no uptake in central necrotic part. Maximum intensity projection (MIP) image show bilateral adrenal masses (arrows). The diagnosis of pheochromocytoma was made and confirmed with histopathology. Note should be made of other foci of uptake in bones (arrows) due to uptake of the tracer in bone metastasis from medullary carcinoma of thyroid
Mentions: Somatostatin receptor imaging might be considered as a supplement for MIBG scintigraphy in pheochromocytoma and paragangliomas patients with suspected metastatic disease.[12] From in vitro and in vivo studies, it has been established that somatostatin receptor subtypes 3 and 4 are expressed in pheochromocytoma, including adrenal and metastatic disease.[19] In-111pentetreotide (Octreoscan; Mallinckrodt Inc.) has only moderate affinity for these subtypes, compared with subtypes 2 and 5, Somatostatin receptor scintigraphy (SRS) has been used with variable results to detect this tumor.[2021] It has higher sensitivity for detecting metastatic pheochromocytoma than for detecting benign pheochromocytoma.[22] Newer somatostatin analogues like 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid -Tyr3-octreotide (DOTATOC) have shown favourable characteristics in imaging with high affinity for somatostatin receptors and a stable and easy process of labelling.[23] Although most existing somatostatin-based tracers only have affinity for the somatostatin receptor subtype 2, which is not always present on pheochromocytoma and paraganglioma cells, newer compounds, such as 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid-1-NaI3-Octreotide (DOTANOC), also have affinity for other somatostatin receptor subtypes.[24] Kroiss et al. compared Ga-68 DOTANOC spositron emission tomography (PET)-CT with I-123MIBG scintigraphy in patients with pheochromocytoma.[25] In pheochromocytoma patients, on a per-lesion basis, the sensitivity of Ga-68DOTA-TOC was 91.7% and that of I-123MIBG was 63.3%. Our experience is similar, with Ga-68 DOTANOC/TOC being better than I-131 MIBG for detecting extra adrenal pheochromocytoma, smaller lesions and lesions with central necrosis [Figure 3].

Bottom Line: Common endocrine causes of hypertension include pheochromocytoma, Cushing's syndrome, primary hyperaldosteronism, and thyroid disorders.It has established role in patients of pheochromocytoma/paraganglioma, Cushing's syndrome, aldosteronism, and thyroid disorders.We present a brief overview of role of nuclear medicine imaging in endocrine hypertension.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT
Endocrine hypertension forms a small (< 5%) but curable subset of patients with hypertension. Common endocrine causes of hypertension include pheochromocytoma, Cushing's syndrome, primary hyperaldosteronism, and thyroid disorders. Nuclear medicine imaging plays an important role in evaluation of patients with endocrine hypertension. It has established role in patients of pheochromocytoma/paraganglioma, Cushing's syndrome, aldosteronism, and thyroid disorders. We present a brief overview of role of nuclear medicine imaging in endocrine hypertension. Development of newer radiotracers might further broaden the role of nuclear medicine in these patients.

No MeSH data available.


Related in: MedlinePlus