Adrenal cortical and medullary imaging

Area of Science:

• Endocrinology
• Radiology
• Nuclear Medicine

Background:

• Adrenal diseases present as endocrine dysfunction or anatomic abnormalities.
• Advances in in vitro assays and pathology understanding enable more accurate diagnosis.
• Cross-sectional imaging and functional radiopharmaceuticals are key diagnostic tools.

Purpose of the Study:

• To outline an accurate and cost-effective approach to diagnosing adrenal diseases.
• To detail the role of functional and anatomic imaging in evaluating incidental adrenal masses and endocrine disorders.
• To contrast the utility of radiopharmaceuticals (NP-59, MIBG) with cross-sectional imaging (CT, MRI).

Main Methods:

• Review of functional imaging agents: 131I-6-beta-iodomethylnorcholesterol (NP-59) for adrenal cortex and 131I/123I-metaiodobenzylguanidine (MIBG) for adrenal medulla.
• Comparison with anatomic imaging modalities: computed tomography (CT) and magnetic resonance imaging (MRI).
• Analysis of clinical applications in incidental adrenal masses, Cushing's syndrome, primary aldosteronism, adrenal hyperandrogenism, pheochromocytoma, and neuroblastoma.

Main Results:

• Imaging selects patients needing further evaluation for incidental adrenal masses.
• Functional and anatomic imaging correlation is crucial for managing hyperfunctioning endocrine states, preventing unnecessary surgery.
• MIBG and MRI are complementary for neuroblastoma detection and staging.

Conclusions:

• Integrated use of functional and anatomic imaging optimizes adrenal disease diagnosis and management.
• Accurate localization and characterization of adrenal lesions improve patient outcomes.
• Radiopharmaceuticals and cross-sectional imaging offer distinct but complementary roles in adrenal pathology assessment.