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Adrenal Localization in the Adrenocorticotropic Hormone-Independent Cushing Syndrome

Lorraine M. Fig, MB, ChB, MPH; Milton D. Gross, MD; Brahm Shapiro, MB, ChB, PhD; David A. Ehrmann, MD; John E. Freitas, MD; David E. Schteingart, MD; Gary M. Glazer, MD; and Isaac R. Francis, MD
[+] Article, Author, and Disclosure Information

Grant Support: Partial support by grants NCI CA 09015, NIAMDD R01 AM 21477-02RAD, GCRC HEW 3 M01 RR0042-22-S1CLR, The Nuclear Medicine Research Fund, and the Veterans Administration.

Requests for Reprints: Milton D. Gross, MD, Nuclear Medicine Service (115), Veterans Administration Medical Center, 2215 Fuller Road, Ann Arbor, MI 48105.

Current Author Addresses: Drs. Fig, Gross, Shapiro, and Freitas: Department of Internal Medicine, Division of Nuclear Medicine, The University of Michigan and the Veterans Administration Medical Centers, Ann Arbor, MI 48109.

Dr. Ehrmann: Department of Internal Medicine, Division of Endocrinology and Metabolism, Pritzker School of Medicine, the University of Chicago, Chicago, IL 60637.

Dr. Schteingart: Department of Internal Medicine, Division of Endocrinology and Metabolism, The University of Michigan, Ann Arbor, MI 48109.

Drs. Glazer and Francis: The Department of Radiology, the University of Michigan, Ann Arbor, MI 48109.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(7):547-553. doi:10.7326/0003-4819-109-7-547
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Study Objective: To assess the efficacy of 131I-6-beta-iodomethylnorcholesterol scintigraphy in the adrenocorticotropic hormone-independent Cushing syndrome and to compare this with computed tomography.

Design: Retrospective analysis of case series from 1977 to 1987.

Setting: Referral to the Division of Nuclear Medicine at a tertiary-care university medical center.

Patients: Twenty-four patients with a pathologically-confirmed diagnosis of the adrenocorticotropic hormone-independent Cushing syndrome had 131I-6-beta-iodomethylnorcholesterol scintigraphy and, in most cases, computed tomography.

Measurements and Main Results: Using 131I-6-beta-iodomethylnorcholesterol scintigraphy, adenomas were accurately seen as focal, unilateral tracer uptake in 14 of 14 patients. In carcinoma, the classic scintigraphic pattern of bilateral nonvisualization was observed in 3 of 4 patients, with ipsilateral uptake of tracer in 1 patient with a histologically well-differentiated malignancy. Computed tomography done during the same interval depicted abnormal adrenals in all cases of adenoma and carcinoma. In cortical nodular hyperplasia, however, computed tomography identified abnormal pairs of adrenals in only one of four cases studied, whereas scintigraphy showed typical patterns of bilateral increased uptake in all of the cases.

Conclusion:131I-6-beta-iodomethylnorcholesterol scintigraphy accurately shows the location and nature of adrenal dysfunction in the adrenocorticotropic hormone-independent Cushing syndrome and may be particularly useful in identifying the bilateral adrenal involvement in cortical nodular hyperplasia.





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