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11C-Metomidate PET Versus Adrenal Vein Sampling in Primary Aldosteronism

Information source: Helsinki University Central Hospital
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Primary Hyperaldosteronism

Intervention: 11C-Metomidate Positron Emission Tomography (Procedure)

Phase: N/A

Status: Active, not recruiting

Sponsored by: Helsinki University Central Hospital

Official(s) and/or principal investigator(s):
Niina Matikainen, M.D., Ph.D., Principal Investigator, Affiliation: Helsinki University Central Hospital

Summary

Rationale: Primary hyperaldosteronism (PA) is the most frequent and possibly curable form of secondary hypertension. The diagnosis and targeted treatment of PA is essential because of high vascular morbidity associated with PA as compared to essential hypertension with comparable blood pressure levels. PA is usually caused by either a unilateral aldosterone-producing adenoma (APA) or by bilateral adrenal hyperplasia (BAH). Distinction between APA and BAH is critical since the former may be cured by adrenalectomy, and the latter needs life-long medical therapy with mineralocorticoid receptor antagonists (MRA). Studies demonstrate that adrenalectomy benefits also BAH patients with dominant nodule(s) producing the most of aldosterone excess. The distinction between unilateral and bilateral PA can be made by adrenal vein sampling (AVS), as recommended by The Endocrine Society 2008 guideline. Currently, in Finland the diagnosis is based on computed tomography (CT) scanning which does not distinguish between aldosterone-producing and common non-functioning adrenal nodules and has limited accuracy detecting small adrenal masses. Since AVS is invasive, dependent on skilled radiologist and costly, there is a need for an accurate, non-invasive functional imaging such as 11C-metomidate positron emission tomography (MTO-PET). Objective: To assess diagnostic ability of MTO-PET as compared to AVS in PA. Secondary objectives: To compare if standardized uptake values (SUVs)in MTO-PET imaging are similar in histologically diagnosed nodular hyperplasia versus adenoma. To assess the diagnostic accuracy of adrenal CT as compared to MTO-PET and AVS. To assess the complete and partial remission rates (blood pressure response expressed in Daily Defined Dosages, medical therapy, use of potassium supplements) after allocating subjects to MRA-therapy or adrenalectomy at 1 and 5 years.

Clinical Details

Official title: Functional Imaging With 11C-Metomidate Positron Emission Tomography Versus Adrenal Vein Sampling in Differential Diagnosis of Unilateral and Bilateral Aldosterone Secretion in Primary Aldosteronism

Study design: Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Diagnostic

Primary outcome: Standard uptake value (SUV) in 11C metomidate Positron emission tomography (MTO-PET)

Secondary outcome:

Standard uptake value (SUV) in 11C metomidate Positron emission tomography (MTO-PET)

Standard uptake value (SUV) in 11C metomidate Positron emission tomography (MTO-PET)

Blood pressure response

Eligibility

Minimum age: 20 Years. Maximum age: 65 Years. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Biochemically proven PA

- Good general health enabling possible adrenalectomy

- BMI less than 35

Exclusion Criteria:

- Any contraindication for AVS, MTO-PET or CT

- Subjects not willing to consider adrenal surgery

- Pregnancy

- Familial PA

- Suspicion of other tumor than adenoma or hyperplasia in adrenal CT scan

Locations and Contacts

Helsinki University Central Hospital, Helsinki, Finland

Tampere University, Tampere, Finland

University of Turku, Turku, Finland

Additional Information

Starting date: February 2012
Last updated: August 17, 2015

Page last updated: August 20, 2015

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