Back to Search
Start Over
CRH stimulation improves 18 F-FDG-PET detection of pituitary adenomas in Cushing's disease.
- Source :
-
Endocrine [Endocrine] 2019 Jul; Vol. 65 (1), pp. 155-165. Date of Electronic Publication: 2019 May 06. - Publication Year :
- 2019
-
Abstract
- Objective: In MRI-negative cases Cushing's disease (CD), surgeons perform a more extensive exploration of the pituitary gland, with fewer instances of hormonal remission. <superscript>18</superscript> F-fluoro-deoxy-glucose ( <superscript>18</superscript> F-FDG) positron emission tomography (PET) has a limited role in detecting adenomas that cause CD (corticotropinomas). Our previous work demonstrated corticotropin-releasing hormone (CRH) stimulation leads to delayed, selective glucose uptake in corticotropinomas. Here, we prospectively evaluated the utility of CRH stimulation in improving <superscript>18</superscript> F-FDG-PET detection of adenomas in CD.<br />Methods: Subjects with a likely diagnosis of CD (n = 27, 20 females) each underwent two <superscript>18</superscript> F-FDG-PET studies [without and with ovine-CRH (oCRH) stimulation] on a high-resolution PET platform. Standardized-uptake-values (SUV) in the sella were calculated. Two blinded neuroradiologists independently read <superscript>18</superscript> F-FDG-PET images qualitatively. Adenomas were histopathologically confirmed, analyzed for mutations in the USP8 gene and for glycolytic pathway proteins.<br />Results: The mean-SUV of adenomas was significantly increased from baseline (3.6 ± 1.5) with oCRH administration (3.9 ± 1.7; one-tailed p = 0.003). Neuroradiologists agreed that adenomas were visible on 21 scans, not visible on 26 scans (disagreed about 7, kappa = 0.7). oCRH-stimulation led to the detection of additional adenomas (n = 6) not visible on baseline-PET study. Of the MRI-negative adenomas (n = 5), two were detected on PET imaging (one only after oCRH-stimulation). USP8 mutations or glycolytic pathway proteins were not associated with SUV in corticotropinomas.<br />Conclusions: The results of the current study suggest that oCRH-stimulation may lead to increased <superscript>18</superscript> F-FDG uptake, and increased rate of detection of corticotropinomas in CD. These results also suggest that some MRI invisible adenomas may be detectable by oCRH-stimulated FDG-PET imaging.<br />Clinical Trial Information: <superscript>18</superscript> F-FDG-PET imaging with and without CRH stimulation was performed under the clinical trial NIH ID 12-N-0007 (clinicaltrials.gov identifier NCT01459237). The transsphenoidal surgeries and post-operative care was performed under the clinical trial NIH ID 03-N-0164 (clinicaltrials.gov identifier NCT00060541).
- Subjects :
- ACTH-Secreting Pituitary Adenoma metabolism
ACTH-Secreting Pituitary Adenoma pathology
Adenoma metabolism
Adenoma pathology
Adolescent
Adult
Child
Diagnosis, Differential
Female
Humans
Male
Middle Aged
Pituitary ACTH Hypersecretion metabolism
Pituitary ACTH Hypersecretion pathology
Sensitivity and Specificity
Young Adult
ACTH-Secreting Pituitary Adenoma diagnosis
Adenoma diagnosis
Corticotropin-Releasing Hormone metabolism
Fluorodeoxyglucose F18
Pituitary ACTH Hypersecretion diagnosis
Positron-Emission Tomography methods
Subjects
Details
- Language :
- English
- ISSN :
- 1559-0100
- Volume :
- 65
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Endocrine
- Publication Type :
- Academic Journal
- Accession number :
- 31062234
- Full Text :
- https://doi.org/10.1007/s12020-019-01944-7