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Constant high adrenal FDG uptake in PET/CT associated with mitochondrial disease
Mika H Martikainen1, Ulla Hohenthal, Laura Pirilä
1Division of Clinical Neurosciences, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland, mikmar@utu.fi.
Abstract:
We describe a patient with the m.3243A>G mitochondrial DNA mutation who developed sepsis caused by Streptococcus constellatus. In the acute phase of illness, abnormally high uptake of (18)F-FDG was observed in both adrenal glands that appeared anatomically normal. In repeated imaging six months later the adrenal uptake had diminished but remained clearly elevated. We did not observe high adrenal FDG uptake as in the patient described here among 30 patients with Staphylococcus aureus sepsis that were investigated with identical imaging protocol. In sepsis, oxygen consumption and metabolic rate are increased compared to normal metabolism. The observed high adrenal FDG uptake during sepsis in this patient probably reflects the acute metabolic stress induced by the infection. Interestingly, in repeated imaging six months later, the adrenal SUVs had diminished but were still abnormally high: this suggests constant high levels of metabolic stress associated with the mitochondrial disorder.
Insights
A patient with m.3243A>G mitochondrial DNA mutation and Streptococcus constellatus sepsis showed high adrenal gland (18)F-FDG uptake. This indicates significant metabolic stress, persisting even six months post-sepsis, linked to the underlying mitochondrial disorder.
Area of Science:
- Mitochondrial genetics
- Infectious disease
- Nuclear medicine imaging
Background:
- The m.3243A>G mitochondrial DNA mutation is associated with various organ dysfunctions.
- Sepsis triggers a systemic hypermetabolic state.
- Positron emission tomography (PET) with fluorodeoxyglucose (FDG) is used to assess metabolic activity.
Observation:
- A patient with the m.3243A>G mutation developed Streptococcus constellatus sepsis.
- Acute phase imaging revealed abnormally high (18)F-FDG uptake in anatomically normal adrenal glands.
- Repeated imaging six months later showed diminished but still elevated adrenal (18)F-FDG uptake.
Findings:
- Unlike 30 patients with Staphylococcus aureus sepsis, this patient exhibited significant adrenal (18)F-FDG uptake during sepsis.
- The high adrenal uptake likely reflects acute metabolic stress from infection in the context of mitochondrial disease.
- Persistently elevated adrenal uptake suggests chronic metabolic stress linked to the mitochondrial disorder.
Implications:
- This case highlights the potential for heightened adrenal metabolic stress in patients with mitochondrial DNA mutations during sepsis.
- FDG-PET imaging may offer insights into the metabolic consequences of mitochondrial disorders during infectious episodes.
- Further research is warranted to understand the long-term metabolic impact on adrenal glands in this patient population.
