J Korean Med Sci.  2013 Mar;28(3):489-492. 10.3346/jkms.2013.28.3.489.

Utility of F-18 FDG-PET in Detecting Primary Aldosteronism in Patients with Bilateral Adrenal Incidentalomas

• Ko MK
• Park CS
• Byun SS
• Hong JM
• Lee MY
• Kim KH
• Na YW
• Choi HJ
• Nam-Goong
• Kim YI
• Kim ES

• KMID: 1786952
• DOI: http://doi.org/10.3346/jkms.2013.28.3.489

Abstract

In patients with primary aldosteronism who have bilateral adrenal incidentalomas, it is important to identify which adrenal gland is secreting excess aldosterone. Traditionally, adrenal vein sampling (AVS) has been performed for lateralization despite its invasiveness. Here we report a case of bilateral adrenal incidentaloma in which 18-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) was used to identify the functional adrenal mass. A 53-yr-old man was referred to our clinic due to bilateral adrenal incidentalomas (right: 1 cm, left: 2.5 cm) on computed tomography (CT). Given his history of colon cancer, FDG-PET/CT scanning was used to rule out metastasis. Although there was focal hot uptake lesion in the right adrenal gland, the patient was suspected primary aldosteronism clinically more than metastasis because of the patient's underlying hypertension with hypokalemia. It was consistent with the results of AVS. Based on these findings, we propose that FDG-PET/CT can be used instead of AVS to identify the source of primary aldosteronism between two bilateral adrenal incidentalomas.

Keyword

Bilateral Adrenal Incidentaloma; FDG-PET/CT; Primary Aldosteronism

MeSH Terms

Adrenal Gland Neoplasms/*diagnosis/pathology/radionuclide imaging
Adrenal Glands/pathology/surgery
Fluorodeoxyglucose F18/diagnostic use
Humans
Hyperaldosteronism/*diagnosis/pathology
Hypertension/diagnosis
Hypokalemia/diagnosis
Male
Middle Aged
Positron-Emission Tomography and Computed Tomography
Fluorodeoxyglucose F18

Figure

• 

  Fig. 1 Abdominal CT of the patient with both adrenal incidentaloma. Both adrenal incidentalomas were noted on abdominal CT. (A) The one was noted 1-cm sized mass at right side (arrow). (B) Another was noted 2.5-cm sized mass at left side (arrow).

• 

  Fig. 2 FDG-PET/CT of the patient with both adrenal incidentaloma. (A) FDG-PET/CT of the torso showing a focal hypermetabolic lesion (maxSUV = 2.7) in the right adrenal mass (arrow). (B) There was no hypermetabolic foci in the left adrenal mass (arrow).

• 

  Fig. 3 The pathologic findings of right adrenal gland after laparoscopic adrenalectomy. (A) On gross examination, a well-demarcated, golden yellow nodule is noted in the right adrenal gland (black arrow). (B) On microscopic examination, tumor cells of right adrenal gland showed lipid-laden clear cells.

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