title: NP-59 test for preoperative localization of primary hyperaldosteronism.
abstract: OBJECTIVE
  Adrenal venous sampling is generally considered the gold standard to identify unilateral hormone production in cases of primary hyperaldosteronism. The aim of this study is to evaluate whether the iodine-131-6-β-iodomethyl-19-norcholesterol (NP-59) test may represent an alternative in selected cases.
  
  
  METHODS
  Patients submitted to laparoscopic adrenalectomy for suspected primary hyperaldosteronism (n = 27) were retrospectively reviewed. When nuclear medicine tests were preoperatively performed, their results were compared with the histopathologic findings and clinical improvement.
  
  
  RESULTS
  Nuclear medicine tests were realized in 13 patients. In 11 (84.6%), a planar anterior and posterior NP-59 scintigraphy was performed and a SPECT/TC in two (15.4%). Scintigraphy indicated a preoperative lateralization in 12 out of 13 patients (92.3%). When the value of NP-59 tests was based on pathologic results, it showed a sensitivity of 90.9% and a positive predictive value of 83.3%. When the nuclear medicine test's performance was based on postoperative blood pressure control, both sensitivity and positive predictive value were 91.6%.
  
  
  CONCLUSIONS
  Nuclear medicine tests represent a useful tool in the preoperative localisation of primary hyperaldosteronism with a high sensitivity and positive predictive value. In patients with contraindications to adrenal venous sampling like contrast allergies, or when it is inconclusive, scintigraphy can represent a useful and non-invasive alternative.
authors.affiliation: University Hospital La Princesa, Madrid, Spain. marcellodima@gmail.com.
authors.forename: Marcello
authors.identifier: http://orcid.org/0000-0001-6510-7210
authors.initials: M
authors.lastname: Di Martino
authors.affiliation: University Hospital La Princesa, Madrid, Spain.
authors.forename: Iñigo
authors.initials: I
authors.lastname: García Sanz
authors.affiliation: University Hospital La Princesa, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Muñoz de Nova
authors.affiliation: University Hospital La Princesa, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Marín Campos
authors.affiliation: University Hospital La Princesa, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Martínez Martín
authors.affiliation: University Hospital La Princesa, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Domínguez Gadea
mesh_terms: D000301:Adosterol; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000000981:diagnostic imaging* / Q000601:surgery; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D000072098:Single Photon Emission Computed Tomography Computed Tomography
chemical_list: D000301:Adosterol
keywords: Adrenal adenoma; NP-59 SPECT/TC; NP-59 scintigraphy; Primary hyperaldosteronism