ECEESPE2025 Poster Presentations Adrenal and Cardiovascular Endocrinology (169 abstracts)
Real-world experience with 68Ga-Pentixa for positron emission tomography in the management of primary aldosteronism
Linus Hesse 1,2,3 , Anna Herden 4 , James Macfarlane 2 , Daniel Gillett 2 , Tina Kienitz 1,5 , Loreen Richter 1 , Dominik Soll 1 , Dominik Spira 1 , Frederike Butz 6 , Martina Mogl 6 , Federico Collettini 7 , Christian J Strasburger 1,3 , Lukas Maurer 1,3 , Knut Mai 1,3,8 , Mark Gurnell 2 , Christian Furth 4 & Linus Haberbosch 1,2,3
1Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Department of Endocrinology and Metabolism, European Reference Network on Rare Endocrine Diseases (ENDO-ERN), Berlin, Germany; 2Cambridge Endocrine Molecular Imaging Group, Institute of Metabolic Science, University of Cambridge, National Institute for Health Research Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, UK; 3Pituitary Tumor Center of Excellence at Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; 4Department of Nuclear Medicine, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; 5Endocrinology in Charlottenburg, Berlin, Germany; 6Department of General, Visceral and Transplant Surgery, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; 7Department of Radiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; 8Department of Human Nutrition, German Institute of Human Nutrition Potsdam-Rehbruäcke, Nuthetal, Germany
JOINT3298
Background: Identification of unilateral disease in most patients with primary aldosteronism (PA) currently relies on invasive adrenal vein sampling (AVS). Positron emission tomography (PET) of the adrenal glands is emerging as a non-invasive alternative for treatment selection. The C-X-C chemokine receptor type 4 (CXCR4) tracer 68Ga-PentixaFor has shown potential in visualising aldosterone-producing adenomas. However, real-world data for this novel method are still scarce. Here we present the currently largest European single-centre series of 68Ga-PentixaFor PET/CT in patients with PA.
Methods: Between 11/2023 and 01/2025 35 patients underwent 68Ga-PentixaFor PET/CT. The likelihood of unilateral disease was assessed qualitatively (visual inspection) and quantitatively (calculation of SUVmax-ratio). Treatment decisions were based on a combination of PET and AVS (where available). Subsequently, an expert centre for molecular imaging reviewed all PET scans blinded to AVS results. Postoperative outcomes were analysed based on the Primary Aldosteronism Surgery Outcome (PASO) criteria.
Results: PET was successfully completed in 35/35 patients and was reported as suggestive of unilateral disease by the local team in 18 (51%) patients. Of 22 patients who also underwent AVS, 12 (55%) had successful bilateral cannulation; 8 of these (36% of 22) demonstrated unilateral disease (6 were also identified on PET). When (partial) AVS data was combined with PET, high confidence to diagnose unilateral disease was reached for 12/22 (55%) patients who had both investigations. There was good agreement between the initial local and external expert reports in 28/35 (80%) cases. Following a second round of local reading with harmonized criteria (blinded to external reports), concordance increased to 33/35 (94%) cases; in two patients, intermediate probability of unilateral disease was only diagnosed by one centre. At the time of this analysis nine patients had undergone adrenalectomy, two informed by AVS, one informed by PET and AVS, and six informed by PET. Outcome data indicate complete biochemical remission in 2/2 operated patients based on AVS, 5/6 operated patients informed by PET, and 1/1 guided by both. The remaining patient showed partial remission. In two AVS, adverse events were reported (retroperitoneal hematoma, infection) while no adverse events were associated with PET.
Conclusion: Our initial experience with 68Ga-PentixaFor PET/CT highlights its potential as a non-invasive additional modality to AVS for PA subtyping. Combining data from AVS and PET can expand achievement of definitive cure. Further studies are needed to validate PET interpretation criteria and better identify cases in which PET alone might suffice for PA subtyping.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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