18F-FDG PET as a Monitoring Tool to Assess Treatment Response in Bilateral Adrenal Histoplasmosis

Kasaliwal, Rajeev; Bukan, Amol; Asopa, Ramesh; Wanjare, Shashir; Shah, Nalini

doi:10.1097/rlu.0000000000000400

Cited by 12 publications

(10 citation statements)

References 8 publications

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“…However, due to persistent symptoms, she was subjected to adrenal biopsy and diagnosed to have histoplasmosis. With antifungal medications (IV amphotericin B followed by oral itraconazole), there was regression of adrenal masses (right 4.4cm, left 3.8cm) at 19-month follow-up (11). …”

Section: Resultsmentioning

confidence: 99%

Bilateral adrenal masses: a single-centre experience

Lomte¹,

Bandgar²,

Khare³

et al. 2016

Endocrine Connections

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BackgroundBilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited.AimsTo analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses.MethodsRetrospective analysis of 70 patients with bilateral adrenal masses presenting to a single tertiary care endocrine centre from western India (2002–2015).ResultsThe most common aetiology was pheochromocytoma (40%), followed by tuberculosis (27.1%), primary adrenal lymphoma (PAL) (10%), metastases (5.7%), non-functioning adenomas (4.3%), primary bilateral macronodular adrenal hyperplasia (4.3%), and others (8.6%). Age at presentation was less in patients with pheochromocytoma (33 years) and tuberculosis (41 years) compared with PAL (48 years) and metastases (61 years) (P<0.001). The presenting symptoms for pheochromocytoma were hyperadrenergic spells (54%) and abdominal pain (29%), whereas tuberculosis presented with adrenal insufficiency (AI) (95%). The presenting symptoms for PAL were AI (57%) and abdominal pain (43%), whereas all cases of metastasis had abdominal pain. Mean size of adrenal masses was the largest in lymphoma (5.5cm) followed by pheochromocytoma (4.8cm), metastasis (4cm) and tuberculosis (2.1cm) (P<0.001). Biochemically, most patients with pheochromocytoma (92.8%) had catecholamine excess. Hypocortisolism was common in tuberculosis (100%) and PAL (71.4%) and absent with metastases (P<0.001).ConclusionIn evaluation of bilateral adrenal masses, age at presentation, presenting symptoms, lesion size, and biochemical features are helpful in delineating varied underlying aetiologies.

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Section: Resultsmentioning

confidence: 99%

Bilateral adrenal masses: a single-centre experience

Lomte¹,

Bandgar²,

Khare³

et al. 2016

Endocrine Connections

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“…Useful in monitoring intracranial IFI Altini et al 84 Clin Nucl Med 2015 Zygomycosis sp. Metabolic uptake demonstrated increase uptake in keeping with worsening clinical disease when MRI did not show worsening of the rhino-orbito-cerebral IFI Kasaliwal et al 88 Clin Nucl Med 2014 Histoplamosis sp. Metabolic disease activity in adrenal gland and nodes correlated with clinical outcome of comorbidities especially in aging HIV-infected patients.…”

Section: Metabolic Dysfunction Associated With Antiretroviral Therapymentioning

confidence: 88%

Monitoring Response to Therapy

Sathekge

Ankrah

Lawal

et al. 2018

Seminars in Nuclear Medicine

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Monitoring response to treatment is a key element in the management of infectious diseases, yet controversies still persist on reliable biomarkers for noninvasive response evaluation. Considering the limitations of invasiveness of most diagnostic procedures and the issue of expression heterogeneity of pathology, molecular imaging is better able to assay in vivo biologic processes noninvasively and quantitatively. The usefulness of F-FDG-PET/CT in assessing treatment response in infectious diseases is more promising than for conventional imaging. However, there are currently no clinical criteria or recommended imaging modalities to objectively evaluate the effectiveness of antimicrobial treatment. Therapeutic effectiveness is currently gauged by the patient's subjective clinical response. In this review, we present the current studies for monitoring treatment response, with a focus on Mycobacterium tuberculosis, as it remains a major worldwide cause of morbidity and mortality. The role of molecular imaging in monitoring other infections including spondylodiscitis, infected prosthetic vascular grafts, invasive fungal infections, and a parasitic disease is highlighted. The role of functional imaging in monitoring lipodystrophy associated with highly active antiretroviral therapy for human immunodeficiency virus is considered. We also discuss the key challenges and emerging data in optimizing noninvasive response evaluation.

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“…Modern imaging modalities can provide excellent resolution for visualization of infectious processes, but imaging is usually limited to detecting advanced disease states. There are isolated case reports of diagnosing disseminated histoplasmosis with 18-Fluorodeoxyglucose positron emission tomography ( 18 F-FDG-PET/CT) [38][39][40][41]. In areas where Histoplasma is endemic, certain findings, such as adrenal masses with intense FGD uptake, should raise suspicion for histoplasmosis but does not provide a definitive diagnosis of histoplasmosis [41].…”

Section: Diagnosismentioning

confidence: 99%

Histoplasmosis in Liver Transplant Recipients: Case Reports and a Review of the Literature

Spallone¹,

Dhal²,

Woc-Colburn³

et al. 2020

OBM Transplantation

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We report two cases of histoplasmosis in orthotopic liver transplant (OLT) recipients to illustrate the variable presentations, complications encountered during treatment, the spectrum of diagnostic modalities, and case outcomes. Case 1 describes the insidious presentation of presumed gastrointestinal histoplasmosis 12 years after OLT, which was defined by months of intermittent diarrhea and focal colonic disease on colonoscopy. A diagnosis of Histoplasma capsulatum was ultimately made by broad range PCR performed on colonic tissue. Due to the patient's inability to tolerate itraconazole, treatment consisted of two weeks of liposomal amphotericin B with resolution of colonic ulcers on follow-up colonoscopy. Case 2 illustrates a case of severe pulmonary histoplasmosis with dissemination in an OLT recipient one year after transplantation. Treatment was complicated by the development of acute respiratory distress syndrome requiring mechanical ventilation and hemodynamic shock requiring extracorporeal membrane oxygenation therapy. A review of the literature on histoplasmosis in OLT recipients accompanies our cases and emphasizes the epidemiology, clinical manifestations, diagnosis, treatment, and prevention.

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18F-FDG PET as a Monitoring Tool to Assess Treatment Response in Bilateral Adrenal Histoplasmosis

Cited by 12 publications

References 8 publications

Bilateral adrenal masses: a single-centre experience

Bilateral adrenal masses: a single-centre experience

Monitoring Response to Therapy

Histoplasmosis in Liver Transplant Recipients: Case Reports and a Review of the Literature

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