Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2021) 77 OC4.3 | DOI: 10.1530/endoabs.77.OC4.3

1University of Cambridge, Cambridge, United Kingdom; 2Wellcome-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, United Kingdom; 3Addenbrooke’s Hospital, Cambridge, United Kingdom; 4Department of Metabolic and Cardiovascular Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; 5Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; 6Royal Liverpool & Broadgreen University Hospital Trusts, Liverpool, United Kingdom; 7University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 8Department of Endocrinology, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom; 9Centre for Endocrinology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; 10NIHR Barts Hospital Biomedical Research Centre, London, United Kingdom


Background: Primary aldosteronism (PA) is the leading, potentially reversible, cause of secondary hypertension. For most patients in whom surgery is being considered, adrenal vein sampling (AVS) is recommended to distinguish unilateral and bilateral causes. However, AVS remains technically challenging, and a significant proportion of patients are unable to progress to surgery because AVS is unavailable or unsuccessful. We have explored whether [11C]Metomidate PET/CT (MTO-PET), used alone or in combination with AVS, can increase the proportion of patients proceeding to surgery.

Methods: We report a retrospective case series of 111 consecutive patients referred to Cambridge for MTO-PET between January 2016 and December 2019. Patients recruited to clinical trials and those included in previous published case series were excluded from the analyses. MTO-PET/CT was interpreted jointly by two experienced clinicians and assigned a probability (low, medium or high) of unilateral disease. Where available, findings from AVS were not disclosed until scoring of MTO-PET/CT was complete. Biochemical and clinical success following surgery were judged according to PASO criteria.

Results: 47 (42.3%) patients were recommended for surgery, of which 31 (27.9%) proceeded to adrenalectomy. In the surgical cohort, 19 patients had a high probability of unilateral disease on MTO-PET and complete biochemical success was observed in 18/19, with all achieving at least partial clinical success. 12 patients were assigned an intermediate probability of unilateral disease, with five proceeding to surgery based on MTO-PET/CT alone. In seven patients, findings from MTO-PET/CT were combined with AVS to inform decision-making. Complete biochemical success was achieved in 11/12 patients, with partial clinical success in all patients.

Conclusion: In a subgroup of PA patients previously unable to progress on the management pathway due to challenges with AVS, we have shown that MTO-PET can reliably identify patients with unilateral disease to allow successful surgery.

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Volume 77

Society for Endocrinology BES 2021

Edinburgh, United Kingdom
08 Nov 2021 - 10 Nov 2021

Society for Endocrinology 

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