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Akkuş G, Güney IB, Ok F, Evran M, Izol V, Erdoğan Ş, Bayazıt Y, Sert M, Tetiker T. Diagnostic efficacy of 18F-FDG PET/CT in patients with adrenal incidentaloma. Endocr Connect 2019; 8:838-845. [PMID: 31137014 PMCID: PMC6599076 DOI: 10.1530/ec-19-0204] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The management of adrenal incidentaloma is still a challenge with respect to determining its functionality (hormone secretion) and malignancy. In this light, we performed 18F-FDG PET/CT scan to assess the SUVmax values in different adrenal masses including Cushing syndrome, pheochromocytoma, primary hyperaldosteronism and non-functional adrenal adenomas. METHODS Total 109 (73 F, 36 M) patients with adrenal mass (incidentaloma), mean age of 53.3 ± 10.2 years (range, 24-70) were screened by 18F-FDG PET/CT. Data of 18F-FDG PET/CT imaging of the patients were assessed by the same specialist. Adrenal masses were identified according to the calculated standardized uptake values (SUVs). Clinical examination, 24-h urine cortisol, catecholamine metabolites, 1-mg dexamethasone suppression test, aldosterone/renin ratio and serum electrolytes were analyzed. RESULTS Based on the clinical and hormonal evaluations, there were 100 patients with non-functional adrenal mass, four with cortisol-secreting, four with pheochromocytomas and one with aldosterone-secreting adenoma. Mean adrenal mass diameter of 109 patients was 2.1 ± 4.3 (range, 1-6.5 cm). The 18F-FDG PET/CT imaging of the patients revealed that lower SUVmax values were found in non-functional adrenal masses (SUVmax 3.2) when compared to the functional adrenal masses including four with cortisol-secreting adenoma (SUVmax 10.1); four with pheochromcytoma (SUVmax 8.7) and one with aldosterone-secreting adenomas (SUVmax 3.30). Cortisol-secreting (Cushing syndrome) adrenal masses showed the highest SUVmax value (10.1), and a cut-off SUVmax of 4.135 was found with an 84.6% sensitivity and 75.6% specificity cortisol-secreting adrenal adenoma. CONCLUSIONS Consistent with the similar studies, non-functional adrenal adenomas typically do not show increased FDG uptake and a certain form of functional adenoma could present various FDG uptake in FDG PET/CT. Especially functional adrenal adenomas (cortisol secreting was the highest) showed increased FDG uptake in comparison to the non-functional adrenal masses. Therefore, setting a specific SUVmax value in the differentiation of malignant adrenal lesion from the benign one is risky and further studies, including a high number of functional adrenal mass are needed.
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Affiliation(s)
- Gamze Akkuş
- Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey
- Correspondence should be addressed to G Akkuş:
| | - Isa Burak Güney
- Nuclear Medicine Department, Cukurova University Medical Faculty, Adana, Turkey
| | - Fesih Ok
- Urology Department, Cukurova University Medical Faculty, Adana, Turkey
| | - Mehtap Evran
- Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey
| | - Volkan Izol
- Urology Department, Cukurova University Medical Faculty, Adana, Turkey
| | - Şeyda Erdoğan
- Pathology Department, Cukurova University Medical Faculty, Adana, Turkey
| | - Yıldırım Bayazıt
- Urology Department, Cukurova University Medical Faculty, Adana, Turkey
| | - Murat Sert
- Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey
| | - Tamer Tetiker
- Division of Endocrinology, Internal Medicine and Endocrinology, Cukurova University Medical Faculty, Department of Internal Medicine, Adana, Turkey
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Patel D, Gara SK, Ellis RJ, Boufraqech M, Nilubol N, Millo C, Stratakis CA, Kebebew E. FDG PET/CT Scan and Functional Adrenal Tumors: A Pilot Study for Lateralization. World J Surg 2016; 40:683-9. [PMID: 26324161 DOI: 10.1007/s00268-015-3242-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with Cushing's Syndrome (CS) and Conn's Syndrome with bilateral adrenal masses pose a dilemma. Uptake of 18F-FDG by hyperfunctioning adrenal glands has not been previously reported and may help lateralize. The aim was to determine if 18F-FDG PET/CT scan could identify hyperfunctioning adrenal masses and determine a biological basis for uptake. METHODS Patients with nonfunctional adenomas (n = 9), CS (n = 11), and Conn's syndrome (n = 4) underwent an 18F-FDG PET/CT scan with a volume of interest circumscribing each mass to obtain a maximal standardized uptake value (SUVmax). Thirty-two adrenal masses were analyzed. Genome-wide expression data from an independent cohort were analyzed in nonfunctioning adenomas (n = 20), Conn's syndrome (n = 29), and CS (n = 24) focusing on GLUT genes. For genes differentially expressed, immunohistochemistry was performed on tissue samples. RESULTS Cortisol-secreting masses (n = 16) had a higher average SUVmax of 5.9 compared to nonfunctioning masses (n = 11, average SUVmax 4.2) and aldosterone-hypersecreting masses (n = 5, average SUVmax 3.2) (p = 0.007). SUVmax cut-off of 5.33 had 50.0% sensitivity and 81.8% specificity in localizing a cortisol-secreting mass. GLUT3 expression was 2.19-fold higher in patients with CS compared to patients with nonfunctioning adenomas (p = 0.003) and 2.16-fold higher in patients with CS compared to Conn's syndrome (p = 0.006). GLUT3 immunohistochemistry showed 2.2-fold higher staining in CS tumor samples compared to nonfunctioning adenomas. CONCLUSIONS Differential 18F-FDG PET/CT uptake was observed in patients with nonfunctioning, aldosterone-hypersecreting, and cortisol-secreting masses. GLUT3 overexpression in cortisol-secreting tumor likely accounts for the differential uptake. Future larger cohort studies will need to be conducted to determine if 18F-FDG PET/CT uptake can lateralize cortisol-secreting adrenal masses in patients with bilateral adrenal masses.
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Affiliation(s)
- Dhaval Patel
- Endocrine Oncology Branch, Clinical Research Center, National Cancer Institute, NIH, Building 10-CRC, Room 3-5840, Bethesda, MD, 20892, USA
| | - Sudheer Kumar Gara
- Endocrine Oncology Branch, Clinical Research Center, National Cancer Institute, NIH, Building 10-CRC, Room 3-5840, Bethesda, MD, 20892, USA
| | - Ryan J Ellis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Myriem Boufraqech
- Endocrine Oncology Branch, Clinical Research Center, National Cancer Institute, NIH, Building 10-CRC, Room 3-5840, Bethesda, MD, 20892, USA
| | - Naris Nilubol
- Endocrine Oncology Branch, Clinical Research Center, National Cancer Institute, NIH, Building 10-CRC, Room 3-5840, Bethesda, MD, 20892, USA
| | - Corina Millo
- PET Department, Clinical Center, NIH, Bethesda, MD, 20892, USA
| | - Constantine A Stratakis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, 20892, USA
| | - Electron Kebebew
- Endocrine Oncology Branch, Clinical Research Center, National Cancer Institute, NIH, Building 10-CRC, Room 3-5840, Bethesda, MD, 20892, USA.
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