REVIEW  NUCLEAR ENDOCRINOLOGY IN THE ERA OF PRECISION MEDICINE 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2022 June;66(2):104-15

DOI: 10.23736/S1824-4785.22.03449-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Integration of molecular imaging in the personalized approach of patients with adrenal masses

Margherita LORUSSO ¹, Vittoria RUFINI ^{2, 3}, Carmela DE CREA ^{3, 4} ✉, Francesco PENNESTRÌ ^{3, 4}, Rocco BELLANTONE ^{3, 4}, Marco RAFFAELLI ^{3, 4}

¹ PET/CT Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; ² Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy; ³ Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; ⁴ Università Cattolica del Sacro Cuore, Rome, Italy

Adrenal masses are a frequent finding in clinical practice. Many of them are incidentally discovered with a prevalence of 4% in patients undergoing abdominal anatomic imaging and require a differential diagnosis. Biochemical tests, evaluating hormonal production of both adrenal cortex and medulla (in particular, mineralocorticoids, glucocorticoids and catecholamines), have a primary importance in distinguishing functional or non-functional lesions. Conventional imaging techniques, in particular computerized tomography (CT) and magnetic resonance imaging (MRI), are required to differentiate between benign and malignant lesions according to their appearance (size stability, contrast enhanced CT and/or chemical shift on MRI). In selected patients, functional imaging is a non-invasive tool able to explore the metabolic pathways involved thus providing additional diagnostic information. Several single photon emission tomography (SPET) and positron emission tomography (PET) radiopharmaceuticals have been developed and are available, each of them suitable for studying specific pathological conditions. In functional masses causing hypersecreting diseases (mainly adrenal hypercortisolism, primary hyperaldosteronism and pheochromocytoma), functional imaging can lateralize the involvement and guide the therapeutic strategy in both unilateral and bilateral lesions. In non-functioning adrenal masses with inconclusive imaging findings at CT/MR, [¹⁸F]-FDG evaluation of tumor metabolism can be helpful to characterize them by distinguishing between benign nodules and primary malignant adrenal disease (mainly adrenocortical carcinoma), thus modulating the surgical approach. In oncologic patients, [¹⁸F]-FDG uptake can differentiate between benign nodule and adrenal metastasis from extra-adrenal primary malignancies.

KEY WORDS: Functional neuroimaging; Radiopharmaceuticals; Fluorodeoxyglucose F18; Precision medicine