Adrenal (131)I-6β-iodomethylnorcholesterol scintigraphy in choosing the side for adrenalectomy in bilateral adrenal tumors with subclinical hypercortisolemia

Lucyna Papierska, Jarosław Ćwikła, Michał Rabijewski, Piotr Glinicki, Maciej Otto, Anna Kasperlik-Załuska, Lucyna Papierska, Jarosław Ćwikła, Michał Rabijewski, Piotr Glinicki, Maciej Otto, Anna Kasperlik-Załuska

Abstract

Purpose: Adrenal scintigraphy with 131I-6β-iodomethylnorcholesterol is considered by several authors the gold standard for assessing tumors with subclinical hypercortisolemia. However, most of the described series consist mainly of cases with unilateral lesions. The aim of our study was to assess whether scintigraphy is useful in choosing the adrenalectomy side in the case of bilateral adrenal tumors with subclinical hypercortisolemia.

Methods: The study focused on 15 consecutive patients with benign bilateral adrenal tumors and subclinical hypercortisolemia. The scintigraphy with 131I-6β-iodomethylnorcholesterol was performed. Fourteen patients underwent unilateral adrenalectomy; the gland with predominant uptake on scintigraphy was removed. Cortisol and ACTH concentrations were measured one and six months after surgery. Post-dexamethasone cortisolemia was assessed six months after surgery. To date, the patients have been under postoperative observation for 1-4 years.

Results: Four patients showed unilateral uptake of radiotracer, and nine patients showed predominant accumulation of radiotracer in one of the adrenal glands. The smaller tumor was predominant in 2 cases. Percentage of activity on the predominant side correlates positively with the difference between tumors' diameters. Unilateral uptake of radiotracer predicts long-lasting postoperative insufficiency of the second adrenal gland. Excision of predominating tumor led to cessation of hypercortisolemia in all patients.

Conclusions: The corticoadrenal scintigraphy is useful in choosing the side for operation in the case of bilateral adrenal tumors with subclinical hypercortisolemia.

Keywords: Adrenal scintigraphy; Bilateral adrenal tumors; Iodomethylnorcholesterol scintigraphy; Subclinical hypercortisolemia.

Figures

Fig. 1
Fig. 1
Unilateral uptake of the tracer in the right adrenal gland (with the bigger tumor). a CT (the arrows point to the both tumors); b anterior planar view of scintigraphic study; c posterior planar view.
Fig. 2
Fig. 2
Predominant radiotracer accumulation (85%) in the left adrenal gland (with the bigger tumor). a, b CT (the arrows point to the both tumors); c anterior planar view of scintigraphic study; d posterior planar view.
Fig. 3
Fig. 3
Predominant uptake in the left, smaller tumor with trace accumulation in the right (harbouring the bigger lesion) adrenal gland. a CT (the arrows point to the both tumors); b anterior planar view of scintigraphic study; c posterior planar view.
Fig. 4
Fig. 4
Percentage of activity on the predominant side correlates positively with the difference between diameters of the tumors.

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