Scintigraphy with 131I-19-iodocholesterol in adrenal disease

Scintigraphic localization of adrenal lesions in primary aldosteronism

Dexamethasone suppression adrenal cortical scintiscanning was performed in 87 patients with primary aldosteronism. Fifty patients had adrenal cortical adenomas and 37 had bilateral adrenal hyperplasia. The diagnosis of adrenal cortical adenoma was confirmed by surgery in 49 of 50, and bilateral adrenal hyperplasia was confirmed by adrenal vein aldosterone sampling in 33 and at operation in four. Dexamethasone suppression adrenal scintigraphy correctly identified the lesion(s) in 82 of the 87 patients. There were three false-negative and two false-positive adrenal cortical scintiscanning results. Computed tomography was performed in 33 patients and correctly identified 14 of 23 patients with adrenal cortical adenomas and two of 10 patients with bilateral adrenal hyperplasia and bilateral enlarged adrenals, whereas the remaining eight were considered to have normal findings. These data indicate that, when properly performed, adrenal cortical scintigraphy is an accurate and efficacious modality for the localization of adrenal cortical adenomas and in the differentiation of adrenal cortical adenoma from bilateral adrenal hyperplasia in primary aldosteronism.

Adrenal scintigraphy with 131I-19-iodochlesterol in the diagnosis of Cushing's syndrome associated with adrenal tumor

Seven patients with Cushing's syndrome secondary to adrenocortical tumors were studied using 131I-19-iodocholesterol. The diagnosis of all cases were verified histologically. In three cases with adenoma the uptake of the tracer was in the tumor only, while the two patients with adrenocortical carcinoma failed to show adrenal accumulation of the labelled compound. In two patients there was a hyperplasia-like scintigraphic pattern, while the stimulation and suppression biochemical tests suggested adrenal tumor. One of these cases was verified as a mixed form (adenoma plus hyperplasia), and the tumor bearing gland was significantly larger on the scan which helped the preoperative localization. In the other case, verified as bilateral multiple adrenocortical adenomas, the autonomus function of both adrenals was proved by dexamethasone suppression scanning. It seens reasonable to use the latter as an adunctive diagnostic procedure in patients where there is a discrepancy between the standart scintiscan and the biochemical indexes of adrenal hyperfunction.

Late functioning adrenocortical carcinoma in a 5-year-old girl

A 5-year-old with adrenocortical carcinoma presented with acute paraplegia. The tumour was initially nonfunctioning but finally showed rapid dissemination and the patient then developed Cushingoid features and virilisation.

Adrenal aldosterone-producing adenoma: use of colonic potential in diagnosis and subtraction scanning technique for localisation

Primary hyperaldosteronism is a potentially curable cause of hypertension, and much interest has been shown in methods of diagnosing the associated hypokalaemic hypertension and localising the adrenal adenoma. In two patients the diagnosis of primary aldosteronism was confirmed by colonic potential measurement and the adenoma localised by a new subtraction technique for early adrenal imaging applied to the use of 131I-19-iodocholesterol. Both patients underwent adrenalectomy and in each case an adenoma was removed. Blood pressure and electrolyte levels returned to normal after operation. In one patient bilateral adrenal phlebography had failed to show the tumour, and sampling of aldosterone concentrations in the adrenal veins had been unsatisfactory.