Top

Published in:

01-03-2017 | ORIGINAL ARTICLE

NP-59 test for preoperative localization of primary hyperaldosteronism

Authors: Marcello Di Martino, Iñigo García Sanz, Jose Luis Muñoz de Nova, Cristina Marín Campos, Miguel Martínez Martín, Luis Domínguez Gadea

Published in: Langenbeck's Archives of Surgery | Issue 2/2017

Abstract

Purpose

Adrenal venous sampling is generally considered the gold standard to identify unilateral hormone production in cases of primary hyperaldosteronism. The aim of this study is to evaluate whether the iodine-131-6-β-iodomethyl-19-norcholesterol (NP-59) test may represent an alternative in selected cases.

Methods

Patients submitted to laparoscopic adrenalectomy for suspected primary hyperaldosteronism (n = 27) were retrospectively reviewed. When nuclear medicine tests were preoperatively performed, their results were compared with the histopathologic findings and clinical improvement.

Results

Nuclear medicine tests were realized in 13 patients. In 11 (84.6%), a planar anterior and posterior NP-59 scintigraphy was performed and a SPECT/TC in two (15.4%). Scintigraphy indicated a preoperative lateralization in 12 out of 13 patients (92.3%). When the value of NP-59 tests was based on pathologic results, it showed a sensitivity of 90.9% and a positive predictive value of 83.3%. When the nuclear medicine test’s performance was based on postoperative blood pressure control, both sensitivity and positive predictive value were 91.6%.

Conclusions

Nuclear medicine tests represent a useful tool in the preoperative localisation of primary hyperaldosteronism with a high sensitivity and positive predictive value. In patients with contraindications to adrenal venous sampling like contrast allergies, or when it is inconclusive, scintigraphy can represent a useful and non-invasive alternative.

Harvey AM (2014) Hyperaldosteronism: diagnosis, lateralization, and treatment. Surg Clin North Am 94:643–656CrossRefPubMed

Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L et al (2004) Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 89:1045–1050CrossRefPubMed

Carey RM (2012) Primary aldosteronism. J Surg Oncol 106:575–579CrossRefPubMed

Economopoulos KP, Phitayakorn R, Lubitz CC, Sadow PM, Parangi S, Stephen AE et al (2016) Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy? Surgery 159:240–249CrossRefPubMed

McKenzie TJ, Lillegard JB, Young WF Jr, Thompson GB (2009) Aldosteronomas—state of the art. Surg Clin North Am 89:1241–1253CrossRefPubMed

Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M et al (2008) Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93:3266–3281CrossRefPubMed

White ML, Gauger PG, Doherty GM, Cho KJ, Thompson NW, Hammer GD et al (2008) The role of radiologic studies in the evaluation and management of primary hyperaldosteronism. Surgery 144:926–933 discussion 33CrossRefPubMed

Rossi GP, Sacchetto A, Chiesura-Corona M, De Toni R, Gallina M, Feltrin GP et al (2001) Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab 86:1083–1090CrossRefPubMed

Hammarstedt L, Muth A, Wangberg B, Bjorneld L, Sigurjonsdottir HA, Gotherstrom G et al (2010) Adrenal lesion frequency: a prospective, cross-sectional CT study in a defined region, including systematic re-evaluation. Acta Radiol 51:1149–1156CrossRefPubMed

10.

Rossi GP, Auchus RJ, Brown M, Lenders JW, Naruse M, Plouin PF et al (2014) An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension 63:151–160CrossRefPubMed

11.

Aronova A, Iii TJ, Zarnegar R (2014) Management of hypertension in primary aldosteronism. World J Cardiol 6:227–233PubMedPubMedCentral

12.

Abad-Cardiel M, Alvarez-Alvarez B, Luque-Fernandez L, Fernandez C, Fernandez-Cruz A, Martell-Claros N (2013) Hypertension caused by primary hyperaldosteronism: increased heart damage and cardiovascular risk. Rev Esp Cardiol (Engl Ed) 66:47–52CrossRef

13.

Sigurjonsdottir HA, Gronowitz M, Andersson O, Eggertsen R, Herlitz H, Sakinis A et al (2012) Unilateral adrenal hyperplasia is a usual cause of primary hyperaldosteronism. Results from a Swedish screening study BMC Endocr Disord 12:17PubMed

14.

Chao CT, Wu VC, Kuo CC, Lin YH, Chang CC, Chueh SJ et al (2013) Diagnosis and management of primary aldosteronism: an updated review. Ann Med 45:375–383CrossRefPubMed

15.

Nishikawa T, Omura M, Satoh F, Shibata H, Takahashi K, Tamura N et al (2011) Guidelines for the diagnosis and treatment of primary aldosteronism—the Japan Endocrine Society 2009. Endocr J 58:711–721CrossRefPubMed

16.

Lumachi F, Marzola MC, Zucchetta P, Tregnaghi A, Cecchin D, Favia G et al (2003) Non-invasive adrenal imaging in primary aldosteronism. Sensitivity and positive predictive value of radiocholesterol scintigraphy, CT scan and MRI. Nucl Med Commun 24:683–688CrossRefPubMed

17.

Yen RF, Wu VC, Liu KL, Cheng MF, Wu YW, Chueh SC et al (2009) 131I-6beta-iodomethyl-19-norcholesterol SPECT/CT for primary aldosteronism patients with inconclusive adrenal venous sampling and CT results. J Nucl Med 50:1631–1637CrossRefPubMed

18.

Chen YC, Su YC, Wei CK, Chiu JS, Tseng CE, Chen SJ et al (2011) Diagnostic value of I-131 NP-59 SPECT/CT scintigraphy in patients with subclinical or atypical features of primary aldosteronism. J Biomed Biotechnol 2011:209787PubMedPubMedCentral

19.

Sarkar SD, Cohen EL, Beierwaltes WH, Ice RD, Cooper R, Gold EN (1977) A new and superior adrenal imaging agent, 131I-6beta-iodomethyl-19-nor-cholesterol (NP-59): evaluation in humans. J Clin Endocrinol Metab 45:353–362CrossRefPubMed

20.

Nocaudie-Calzada M, Huglo D, Lambert M, Ernst O, Proye C, Wemeau JL et al (1999) Efficacy of iodine-131 6beta-methyl-iodo-19-norcholesterol scintigraphy and computed tomography in patients with primary aldosteronism. Eur J Nucl Med 26:1326–1332PubMed

21.

Kazerooni EA, Sisson JC, Shapiro B, Gross MD, Driedger A, Hurwitz GA et al (1990) Diagnostic accuracy and pitfalls of [iodine-131]6-beta-iodomethyl-19-norcholesterol (NP-59) imaging. J Nucl Med 31:526–534PubMed

22.

Ikeda DM, Francis IR, Glazer GM, Amendola MA, Gross MD, Aisen AM (1989) The detection of adrenal tumors and hyperplasia in patients with primary aldosteronism: comparison of scintigraphy, CT, and MR imaging. AJR Am J Roentgenol 153:301–306CrossRefPubMed

23.

Gross MD, Shapiro B, Grekin RJ, Freitas JE, Glazer G, Beierwaltes WH et al (1984) Scintigraphic localization of adrenal lesions in primary aldosteronism. Am J Med 77:839–844CrossRefPubMed

24.

Chen YC, Wei CK, Chen PF, Tzeng JE, Chuang TL, Wang YF (2009) Seeking the invisible: I-131 NP-59 SPECT/CT for primary hyperaldosteronism. Kidney Int 75:663CrossRefPubMed

25.

Hennings J, Sundin A, Hagg A, Hellman P (2010) 11C-metomidate positron emission tomography after dexamethasone suppression for detection of small adrenocortical adenomas in primary aldosteronism. Langenbeck’s Arch Surg 395:963–967CrossRef

26.

Burton TJ, Mackenzie IS, Balan K, Koo B, Bird N, Soloviev DV et al (2012) Evaluation of the sensitivity and specificity of (11)C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn’s adenomas. J Clin Endocrinol Metab 97:100–109CrossRefPubMed

27.

Powlson AS, Gurnell M, Brown MJ (2015) Nuclear imaging in the diagnosis of primary aldosteronism. Curr Opin Endocrinol Diabetes Obes 22:150–156CrossRefPubMedPubMedCentral

28.

Hahner S, Kreissl MC, Fassnacht M, Haenscheid H, Bock S, Verburg FA et al (2013) Functional characterization of adrenal lesions using [123I]IMTO-SPECT/CT. J Clin Endocrinol Metab 98:1508–1518CrossRefPubMed

Title: NP-59 test for preoperative localization of primary hyperaldosteronism
Authors: Marcello Di Martino
Iñigo García Sanz
Jose Luis Muñoz de Nova
Cristina Marín Campos
Miguel Martínez Martín
Luis Domínguez Gadea
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1561-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

NP-59 test for preoperative localization of primary hyperaldosteronism

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2017

Diagnostic value of conventional chest radiography in intrathoracic goiters—retrospective analysis of 2570 patients

Assessment of the Aldosteronona resolution score as a predictive resolution score of hypertension after adrenalectomy for aldosteronoma in French patients

Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients

The need of prophylactic central lymph node dissection is controversial in terms of postoperative thyroglobulin follow-up of patients with cN0 papillary thyroid cancer

Risk factors for complications after adrenalectomy: results from a comprehensive national database

Hybrid minimally invasive esophagectomy vs. open esophagectomy: a matched case analysis in 120 patients