SpringerLink
Log in

NP-59 test for preoperative localization of primary hyperaldosteronism

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

NP-59:

Iodine-131-6-β-iodomethyl-19-norcholesterol

PA:

Primary hyperaldosteronism

IAH:

Idiopathic bilateral adrenal hyperplasia

UAH:

Unilateral adrenal hyperplasia

CT:

Computed tomography

MRI:

Magnetic resonance imaging

AVS:

Adrenal Venous Sampling

PPV:

Positive predictive value

ARR:

Aldosterone-to-renin ratio

NM:

Nuclear medicine

SPECT-CT:

Single-photon emission computed tomography

BP:

Blood pressure

TP:

True positive

FN:

False negative

FP:

False positive

NH:

Nodular hyperplasia

SUVmax :

Maximum standarized uptake values

References

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

    Article  PubMed  Google Scholar 

  2. 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 89:1045–1050

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. 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 159:240–249

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. 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 93:3266–3281

    Article  CAS  PubMed  Google Scholar 

  7. 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 33

    Article  PubMed  Google Scholar 

  8. 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 86:1083–1090

    Article  CAS  PubMed  Google Scholar 

  9. 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 51:1149–1156

    Article  PubMed  Google Scholar 

  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 subty** of primary aldosteronism. Hypertension 63:151–160

    Article  CAS  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  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) 66:47–52

    Article  Google Scholar 

  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 12:17

    PubMed  Google Scholar 

  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 45:375–383

    Article  CAS  PubMed  Google Scholar 

  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 58:711–721

    Article  CAS  PubMed  Google Scholar 

  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 24:683–688

    Article  CAS  PubMed  Google Scholar 

  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 50:1631–1637

    Article  CAS  PubMed  Google Scholar 

  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 2011:209787

    PubMed  PubMed Central  Google Scholar 

  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 45:353–362

    Article  CAS  PubMed  Google Scholar 

  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 26:1326–1332

    CAS  PubMed  Google Scholar 

  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 31:526–534

    CAS  PubMed  Google Scholar 

  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 153:301–306

    Article  CAS  PubMed  Google Scholar 

  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 77:839–844

    Article  CAS  PubMed  Google Scholar 

  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 75:663

    Article  PubMed  Google Scholar 

  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 395:963–967

    Article  CAS  Google Scholar 

  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 97:100–109

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 98:1508–1518

    Article  CAS  PubMed  Google Scholar 

Download references

Authors’ contributions

Study conception and design: MDM, IGS. Acquisition of data: MDM, CMC. Analysis and interpretation of data: MDM, JMdN, LDG. Drafting of manuscript: MDM, LDG, MMM. Critical revision of manuscript: IGS.

Author information

Authors and Affiliations

  1. University Hospital La Princesa, Madrid, Spain

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

Authors
  1. Marcello Di Martino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iñigo García Sanz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jose Luis Muñoz de Nova
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cristina Marín Campos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miguel Martínez Martín
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luis Domínguez Gadea
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcello Di Martino.

Ethics declarations

Ethical approval

This study was merely observational and it does not contain any studies with human participants or animals performed by any of the authors.

Funding

None.

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Martino, M., García Sanz, I., Muñoz de Nova, J.L. et al. NP-59 test for preoperative localization of primary hyperaldosteronism. Langenbecks Arch Surg 402, 303–308 (2017). https://doi.org/10.1007/s00423-017-1561-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-017-1561-1

Keywords

Search

Navigation