11C-Metomidate PET-CT versus adrenal vein sampling to subtype primary aldosteronism: a prospective clinical trial

Troy H. Puar, Chin Meng Khoo, Colin Jingxian Tan, Aaron Kian Ti Tong, Michael Chien Sheng Tan, Ada Ee Der Teo, Keng Sin Ng, Kang Min Wong, Anthonin Reilhac, Jim O'Doherty, Celso E. Gomez-Sanchez, Peng Chin Kek, Szemen Yee, Alvin W.K. Tan, Matthew Bingfeng Chuah, Daphne Hui Min Lee, Kuo Weng Wang, Charles Qishi Zheng, Luming Shi, Edward George RobinsRoger Sik Yin Foo

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Objective:Adrenal vein sampling (AVS) is recommended to subtype primary aldosteronism, but it is technically challenging. We compared 11C-Metomidate-PET-computed tomography (PET-CT) and AVS for subtyping of primary aldosteronism.Methods:Patients with confirmed primary aldosteronism underwent both AVS and 11C-Metomidate PET-CT (post-dexamethasone). All results were reviewed at a multidisciplinary meeting to decide on final subtype diagnosis. Primary outcome was accuracy of PET versus AVS to diagnosis of unilateral primary aldosteronism based on post-surgical biochemical cure. Secondary outcome was accuracy of both tests to final subtype diagnosis.Results:All 25 patients recruited underwent PET and successful AVS (100%). Final diagnosis was unilateral in 22 patients, bilateral in two and indeterminate in one due to discordant lateralization. Twenty patients with unilateral primary aldosteronism underwent surgery, with 100% complete biochemical success, and 75% complete/partial clinical success. For the primary outcome, sensitivity of PET was 80% [95% confidence interval (95% CI): 56.3-94.3] and AVS was 75% (95% CI: 50.9-91.3). For the secondary outcome, sensitivity and specificity of PET was 81.9% (95% CI: 59.7-94.8) and 100% (95% CI: 15.8-100), and AVS was 68.2% (95% CI: 45.1-86.1) and 100% (95% CI: 15.8-100), respectively. Twelve out of 20 (60%) patients had both PET and AVS lateralization, four (20%) PET-only, three (15%) AVS-only, while one patient did not lateralize on PET or AVS. Post-surgery outcomes did not differ between patients identified by either test.Conclusion:In our pilot study, 11C-Metomidate PET-CT performed comparably to AVS, and this should be validated in larger studies. PET identified patients with unilateral primary aldosteronism missed on AVS, and these tests could be used together to identify more patients with unilateral primary aldosteronism.Video Abstract:http://links.lww.com/HJH/B918.

Original languageEnglish
Pages (from-to)1179-1188
Number of pages10
JournalJournal of Hypertension
Issue number6
Publication statusPublished or Issued - 1 Jun 2022
Externally publishedYes


  • adrenalectomy
  • adrenocortical adenoma
  • diagnostic testing
  • functional imaging
  • hyperaldosteronism
  • subtyping

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this