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Iodomethylnorcholesterol Uptake in An Aldosteronoma Shown by Dexamethasone-Suppression Scintigraphy: Relationship to Adenoma Size and Functional Activity^*

Department of Medicine (K.N., H.D.), and Department of Surgery (Y.I.), Institute of Clinical Endocrinology, Department of Radiology (K.K., M.M.); Department of Surgical Pathology (M.A.), Tokyo Women's Medical College Tokyo 162, Japan

Address correspondence and reprint requests to: Kaoru Nomura, MD, Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's College, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162, Japan.

Dexamethasone-suppression (DS) adrenal scintigraphy localizes an aldosteronoma, but with false-negative results, i.e. 2 of 19 cases in our study. Our aim was to clarify the clinical meaningfulness of this test. Adrenal iodomethyl-norcholesterol (NP-59) uptake on the adenoma side correlated with the estimated adenoma volume (n = 15, r = 0.843, P < 0.001). Accordingly, the uptake ratio on the adenoma side to that on the opposite side depended on the adenoma volume (r = 0.683, P < 0.01). This explains the false-negative results (uptake ratio < 2) in two cases with small adenomas. The NP-59 uptake correlated weakly with the plasma aldosterone level (r = 0.516, P < 0.05). This result indicates the low correlation between NP- 59 uptake and the ability to secrete aldosterone.

NP-59 accumulation in the surgically removed gland was analyzed by autoradiography in six cases where DS scintigraphy was done just before surgery. The density was higher in the adenoma cells than in the adjacent cortical cells in five cases, but the difference was rather small, i.e., within a 2-fold difference in four cases. In one case, almost the same density was observed in both types of cells.

Thus, the laterality of NP-59 uptake primarily depends on the adenoma volume although NP-59 uptake somewhat reflects the adenoma's ability to secrete aldosterone or the adenoma cell's activity in accumulating NP-59. Care must be taken in interpreting the findings from DS scintigraphy where the adenoma is small or adrenal uptake is low.

^* This study was supported in part by a grant for the treatment of intractable diseases from the Japanese Ministry of Health and Welfare.

Received October 30, 1989.

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