68Ga-Pentixafor PET/CT for the Subtyping Diagnosis of Primary Aldosteronism

This is a prospective study. We will enroll 100 patients with definite diagnosis of PA using adrenal venous sampling(AVS) as the gold standard for subtype to evaluate the value of 68Ga-pentixaforPET/CT in the diagnosis of PA.

Inclusion criteria

• PA diagnosis confirmed by at least one confirmatory test
• willingness to undergo AVS and surgery
• informed consent to participate in the study.

Exclusion criteria

• PA patients who met guideline criteria for bypassing AVS [i.e. younger than 35 years old, with typical APA characteristics (plasma aldosterone >300pg/ml, plasma renin < 2·5mIU/l, serum potassium <3·5mmol/l, CT indicated unilateral 1cm low-density adenoma);
• failed adrenal vein cannulation during AVS;
• Subtyping diagnosis was inconclusive based on AVS results (e.g. aldosterone/cortisol ratio in bilateral adrenal veins lower than the peripheral vein, or missing data);
• pregnant or lactating women;
• patients with a history of uncontrolled malignant tumor;
• concurrent Cushing's syndrome [including mild autonomous cortisol secretion: cortisol after 1mg dexamethasone suppression test (DST)>138 nmol/l or cortisol after 2mg DST >50 nmol/l or cortisol after 1mg DST 50-138 nmol/l plus adrenocorticotrophic hormone (ACTH)<10pg/ml;
• diagnosis of familial hyperaldosteronism;
• imaging characteristics suggestive of pheochromocytoma or adrenal cortical carcinoma;
• unsuitable for surgery, such as heart failure with New York Heart Association (NYHA) class III or IV, severe anemia (Hemoglobin<60g/L), stroke or acute coronary syndrome within 3 months, severe ascites and cirrhosis, estimated glomerulus filtration rate<30ml/min/m;
• alcohol or drug abuse and mental disorders.