SFEBES2026 Oral Communications Mechanisms and Management of Endocrine Disease (5 abstracts)
Imaging adrenal aldosterone synthase expression with [18F]AldoView PET-CT in primary aldosteronism
Erik Arstad 1 , Kerstin Sander 1 , Tom Kurzawinski 2 , Cameron Anderson 2 , Yazead Buhidma 1 , Ramla Awais 1 , Fatih Sirindil 1 , Robert Shortman 2 , Louise Dickinson 2 , Aidan O’Keeffe 3 , John Dickson 2 , Teng-Teng Chung 2 , Morris Brown 4 & Bryan Williams 1
1University College London, London, United Kingdom; 2University College London Hospitals NHS Foundation Trust, London, United Kingdom; 3University of Nottingham, Nottingham, United Kingdom; 4Queen Mary University of London, London, United Kingdom
Primary aldosteronism (PA) results from dysregulated aldosterone secretion, leading to hypertension and cardiovascular, metabolic, and renal disease. Adrenalectomy benefits patients with “unilateral” PA, but it is challenging to identify those patients most likely to benefit. Adrenal venous sampling (AVS), the current reference standard for guiding treatment decision, is technically demanding, invasive, and only available at a few specialised centres. To simplify and improve treatment stratification, we developed [18F]AldoView, the first highly selective aldosterone synthase (CYP11B2)-specific PET radioligand. We present results from the first-in-human study, which evaluated the potential of [18F]AldoView PET-CT to detect aldosterone-producing lesions in 17 consecutive patients with PA who had lateralise on AVS and were scheduled for laparoscopic adrenalectomy. Specificity of tracer binding was assessed by autoradiography and immunohistochemical (IHC) staining for CYP11B1 and CYP11B2 in excised adrenal tissues. [18F]AldoView PET-CT identified one or more focal lesions (total n=22) in all 17 adrenals predicted to be dominant by AVS and additionally revealed microlesions (<1 cm3) in the contralateral glands of five patients. When corrected for lesion size, lateralisation on PET was concordant with AVS in all cases. IHC confirmed dense CYP11B2 expression consistent with aldosterone-producing adenomas in 15 patients and multiple micronodules in two. The binding pattern of [18F]AldoView closely reflected aldosterone synthase expression in tissue sections from the resected adrenals.
Conclusion
[18F]AldoView PET-CT demonstrates high specificity for macro- and microscopic aldosterone synthase-positive lesions. [18F]AldoView may have the potential to transform diagnostic pathways and refine treatment stratification across the spectrum of aldosterone dysregulation. A phase II trial (IDEAL2) is underway to evaluate its performance in a broader population of patients with PA.
Volume 117
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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