NP-59 test for preoperative localization of primary hyperaldosteronism

Martino, Marcello Di; Sanz, Íñigo García; Nova, José Luis Muñoz de; Campos, C.; Martín, Miguel Martínez; Gadea, L. Domínguez

doi:10.1007/s00423-017-1561-1

Cited by 7 publications

(3 citation statements)

References 28 publications

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“…Adrenocortical scintigraphy for PA (131I-6-betaiodomethyl-19-norcholesterol [NP-59]) is performed under dexamethasone suppression. Compared with conventional planner images, NP-59 SPECT/CT improves both the sensitivity and PPV of subtype testing (sensitivity, 40.9% vs. 81.8%; specificity, 66.7% vs. 66.7%; PPV, 75.0% vs. 85.7%) [95,96]. Therefore, dexamethasonesuppressed adrenocortical scintigraphy is an alternative to AVS in patients with a desire and indication for surgery but who cannot undergo AVS due to iodine allergy or other reasons, in patients who do not wish to undergo AVS, or in patients with inconclusive AVS results.…”

Section: Evidence and Commentsmentioning

confidence: 99%

Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021

et al. 2022

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Primary aldosteronism (PA) is associated with higher cardiovascular morbidity and mortality rates than essential hypertension. The Japan Endocrine Society (JES) has developed an updated guideline for PA, based on the evidence, especially from Japan. We should preferentially screen hypertensive patients with a high prevalence of PA with aldosterone to renin ratio ≥200 and plasma aldosterone concentrations (PAC) ≥60 pg/mL as a cut-off of positive results. While we should confirm excess aldosterone secretion by one positive confirmatory test, we could bypass patients with typical PA findings. Since PAC became lower due to a change in assay methods from radioimmunoassay to chemiluminescent enzyme immunoassay, borderline ranges were set for screening and confirmatory tests and provisionally designated as positive. We recommend individualized medicine for those in the borderline range for the next step. We recommend evaluating cortisol cosecretion in patients with adrenal macroadenomas. Although we recommend adrenal venous sampling for lateralization before adrenalectomy, we should carefully select patients rather than all patients, and we suggest bypassing in young patients with typical PA findings. A selectivity index ≥5 and a lateralization index >4 after adrenocorticotropic hormone stimulation defines successful catheterization and unilateral subtype diagnosis. We recommend adrenalectomy for unilateral PA and mineralocorticoid receptor antagonists for bilateral PA. Systematic as well as individualized clinical practice is always warranted. This JES guideline 2021 provides updated rational evidence and recommendations for the clinical practice of PA, leading to improved quality of the clinical practice of hypertension.

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Section: Evidence and Commentsmentioning

confidence: 99%

Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021

et al. 2022

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“…et al series [28]. However, the diagnostic accuracy increased in the last available series, reaching a diagnostic accuracy of 83.3% [19], a sensitivity of 90.9%, and a positive predictive value of 83.3%, according to other authors [29]. This improvement is probably related to the introduction of the simultaneous use of integrated SPECT/CT to provide both functional and anatomical information [12].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Adrenal Iodine-131 6-Beta-Iodomethyl-19-Norcholesterol Scintigraphy for the Subtyping of Primary Aldosteronism

et al. 2023

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Purpose: To evaluate the diagnostic accuracy of the 131I-6β-iodomethyl-19-norcholesterol (NP-59) adrenal scintigraphy for the subtyping diagnosis of primary aldosteronism (PA), considering as gold standard for the diagnosis of unilateral PA (UPA), either the results of the adrenal venous sampling (AVS) or the outcome after adrenalectomy. Methods: A retrospective multicenter study was performed on PA patients from 14 Spanish tertiary hospitals who underwent NP-59 scintigraphy with an available subtyping diagnosis. Patients were classified as UPA if biochemical cure was achieved after adrenalectomy or/and if an AVS lateralization index > 4 with ACTH stimulation or >2 without ACTH stimulation was observed. Patients were classified as having bilateral PA (BPA) if the AVS lateralization index was ≤4 with ACTH or ≤2 without ACTH stimulation or if there was evidence of bilateral adrenal nodules >1 cm in each adrenal gland detected by CT/MRI. Results: A total of 86 patients with PA were included (70.9% (n = 61) with UPA and 29.1% (n = 25) with BPA). Based on the NP-59 scintigraphy results, 16 patients showed normal suppressed adrenal gland uptake, and in the other 70 cases, PA was considered unilateral in 49 patients (70%) and bilateral in 21 (30%). Based on 59-scintigraphy results, 10.4% of the patients with unilateral uptake had BPA, and 27.3% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the NP-59 scintigraphy for PA subtyping was 0.812 [0.707–0.916]. Based on the results of the CT/MRI and NP-59 scintigraphy, only 6.7% of the patients with unilateral uptake had BPA, and 24% of the cases with bilateral uptake had UPA. The AUC of the ROC curve of the model combining CT/MRI and 59-scintigraphy results for subtyping PA was 0.869 [0.782–0.957]. Conclusion: The results of NP-59 scintigraphy in association with the information provided by the CT/MRI may be useful for PA subtyping. However, their diagnostic accuracy is only moderate. Therefore, it should be considered a second-line diagnostic tool when AVS is not an option.

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“…The essence of the method is that for the study, one can use a radioactively noticed predecessor of hormones of the adrenal cortex hormones – cholesterol. For this purpose, 131J-methylnorcholesterol (NP-59) was selected [14, 20].…”

Section: Discussionmentioning

confidence: 99%

Laboratory Diagnostics of Primary Hyperaldosteronism and its Peculiarities (Literature Review)

et al. 2019

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The final stage of the diagnostic of primary hyperaldosteronism is to identify the causes of excessive secretion of aldosterone and determination of its variants. Based on the analysis of literature data, the diagnostic value, sensitivity and specificity of the methods of radiation diagnostics for primary hyperaldosteronism were assessed: ultrasound, computed tomography, magnetic resonance imaging, photon emission tomography, magnetic resonance spectroscopy, scintigraphy with iodine radiopharmaceuticals. The causes of false-positive and false-negative evaluations of changes in adrenal glands in the application of these diagnostics have been analyzed. There are many genetic and morphological studies when searching the literature data on the principles and methods of distinguishing the nosological forms of primary hyperaldosteronism based on the results of the aldosterone level estimation in the separated blood from the central veins of both adrenal glands or segmental veins of one gland with subsequent determination of the concentration gradient. It was noted that topical diagnostics and, especially, the determination of nosological forms of primary hyperaldosteronism are complex and expensive, but their results allow choosing an appropriate treatment approach for each particular case.

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NP-59 test for preoperative localization of primary hyperaldosteronism

Cited by 7 publications

References 28 publications

Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021

Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021

Diagnostic Accuracy of Adrenal Iodine-131 6-Beta-Iodomethyl-19-Norcholesterol Scintigraphy for the Subtyping of Primary Aldosteronism

Laboratory Diagnostics of Primary Hyperaldosteronism and its Peculiarities (Literature Review)

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