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Open Access
CC BY 4.0 · World J Nucl Med
DOI: 10.1055/s-0045-1814732
Original Article

A Novel Non-Invasive Diagnostic Tool for Determining the Subtype of Primary Aldosteronism Using 68Ga Pentixafor PET/CT

Authors

  • Ashish K. Acharya

    1   Department of Nuclear Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India

  • Indirani Muthukrishnan Elangovan

    1   Department of Nuclear Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India

  • Dinesh Kumar Gauthaman 

    1   Department of Nuclear Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India

  • Shelley Simon

    1   Department of Nuclear Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
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Abstract

Background

Primary aldosteronism (PA) may present as either unilateral or bilateral disease. Differentiating unilateral forms—unilateral aldosterone– producing adenoma (APA) and unilateral adrenal hyperplasia—from bilateral forms—bilateral APA, bilateral adrenal hyperplasia (BAH)—is critical, as the management strategies differ. Currently, PA subtyping is performed using adrenal vein sampling (AVS) and computed tomography (CT). However, AVS is invasive and technically demanding, and CT has limited accuracy. CXCR4 (CXC chemokine receptor type 4) expression is higher in APAs than in normal adrenal tissue and non-functional tumors. Pentixafor, a CXCR4-specific ligand labelled with 68Ga, has shown potential for PA subtyping.

Materials and Methods

This prospective observational study included 13 patients with confirmed PA who underwent 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT) and 13 individuals without PA as controls. Both visual and semi-quantitative analyses were used to classify patients with PA into unilateral or bilateral subtypes.

Results

Among the 13 patients with PA, 10 were diagnosed with unilateral primary aldosteronism (UPA) and three with bilateral primary aldosteronism (BPA) based on 68Ga-pentixafor PET/CT. The mean standardized uptake value (SUV)max, SUVratio, and adrenal/liver ratios were significantly higher in patients with UPA than in those with BPA and controls. The 10 patients with UPA underwent adrenalectomy, with histopathological and immunohistochemical analysis confirming the diagnosis. All 10 patients achieved complete biochemical remission post-surgery. The three patients with BPA were started on medical therapy and also achieved biochemical remission.

Conclusion

68Ga-Pentixafor PET/CT is a promising non-invasive imaging modality for PA subtyping and may serve as an alternative to AVS in cases where AVS is inconclusive, non-diagnostic, or contraindicated.

Keywords

Ga-68 Pentixafor PET/CT - primary aldosteronism - CXCR4 - adrenal vein sampling - aldosterone-producing adenoma - bilateral adrenal hyperplasia

Ethical Approval and Consent to Participate

This study was approved by the Institutional Ethics Committee of Apollo Hospitals, Chennai. The study was performed in accordance with the ethical standards as outlined in the Helsinki Declaration as revised in 2023.


Consent for Publication

Written informed consent was obtained from all the individual participants of this study.


Authors' Contributions

All authors contributed to the study conception and design. Data collection and analysis was done by A.K.A. and guided and modified under each step by I.M.E., D.K.G., and S.S.


Data Availability Statement

Image data were extracted from PACS of Apollo Hospitals Chennai, stored in DICOM format. The raw data is not publicly available to preserve individuals' privacy.




Publication History

Article published online:
05 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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