Positive iodine-131 6 beta-iodomethyl-19-norcholesterol (NP-59) adrenal images can precede return of adrenocortical function after o,p' DDD treatment.
A patient with bilateral adrenal hyperplasia, due to the ectopic adrenocorticotrophic hormone (ACTH) syndrome, received a 3-month course of treatment with 1,1 dichloro-2(o-chlorophenyl)-2-(p-chlorophenyl)ethane (o,p' DDD), which caused adrenal hypofunction requiring steroid therapy. Eleven months later, Cushing's syndrome recurred. His CT scan showed a left adrenal gland that was enlarged and a normal-sized right adrenal gland. However, the NP-59 image showed increased uptake by both glands. Venous effluent was sampled from each adrenal vein. The plasma cortisol level from the left gland was 1392 ng/ml, and that from the right gland was 667 ng/ml. The latter value was not significantly different from the values obtained at peripheral sites (517-744 ng/ml). In the course of recovery from o,p' DDD damage, the ability of the adrenal gland to take up NP-59 may be restored before the return of its biosynthetic and secretory functions. Serial NP-59 adrenal images can anticipate the recurrence of Cushing's syndrome after adrenolytic therapy, thereby permitting early retreatment.
Sparagana
M
M
Medical Service, Veterans Administration Hospital, Hines, Illinois.
Ackerman
L
L
D015071:19-Iodocholesterol / Q000031:analogs & derivatives*; D000182:ACTH Syndrome, Ectopic / Q000188:drug therapy*; D000311:Adrenal Glands / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D000328:Adult; D002784:Cholesterol / Q000031:analogs & derivatives*; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D008939:Mitotane / Q000009:adverse effects* / Q000627:therapeutic use; D009384:Paraneoplastic Endocrine Syndromes / Q000188:drug therapy*; D011877:Radionuclide Imaging; D012008:Recurrence
D007457:Iodine Radioisotopes; D015071:19-Iodocholesterol; C035501:6-iodomethylcholesterol; D008939:Mitotane; D002784:Cholesterol