Normotensive primary aldosteronism in a patient with myasthenia gravis: a localization diagnostic conundrum unraveled by 68Ga-pentixafor PET/CT - a case report with review of literature.
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引用次数: 0
Abstract
Purpose: While primary aldosteronism (PA) is typically screened in hypertensive patients, normotensive PA remains underrecognized, especially in complex cases where standard diagnostic approaches fail. We present a challenging case of normotensive PA complicated by myasthenia gravis (MG) requiring chronic glucocorticoids, which interfere with conventional cortisol-based adrenal venous sampling (AVS) interpretation. This case highlights the pivotal role of 68Ga-pentixafor PET/CT as an innovative alternative for subtype differentiation in such complex scenarios.
Methods: A 30-year-old normotensive woman with MG (on long-term glucocorticoids) was incidentally found to have a left adrenal adenoma. Biochemical testing confirmed PA (elevated ARR, positive captopril challenge test and saline infusion test). Due to glucocorticoid interference with AVS interpretation, 68Ga-pentixafor PET/CT was utilized for precise localization. We further reviewed literature on alternative diagnostic strategies for PA when conventional cortisol-based AVS interpretation is compromised.
Results: 68Ga-pentixafor PET/CT successfully localized the aldosterone-producing adenoma, guiding laparoscopic adrenalectomy. Postoperatively, the patient achieved complete biochemical remission (normalized ARR and potassium). To our knowledge, this is the first reported use of 68Ga-pentixafor PET/CT for PA subtype diagnosis in a glucocorticoid-dependent normotensive patient, offering a paradigm for similar challenging cases.
Conclusions: For PA patients with confounding factors affecting cortisol-based AVS interpretation (e.g., chronic glucocorticoid use), 68Ga-pentixafor PET/CT emerges as a robust non-invasive alternative for accurate subtype differentiation. This case provides a novel diagnostic framework for complex PA presentations, advocating for tailored imaging strategies to overcome traditional limitations.
期刊介绍：
Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology.
Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted.
Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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