Evaluating the Functional Status of the Adrenal Glands With [68Ga]Ga-PentixaFor in Hyperaldosteronism and Hypercortisolism

Background:

• [68Ga]Ga-PentixaFor is a PET agent targeting the C-X-C chemokine receptor type 4 (CXCR4) with promising applications in oncology, cardiology, and infectious disease.
• CXCR4 has also been noted to show high expression in many aldosterone-producing adenomas (APA) and some cortisol-producing adenomas (CPA) but not usually in nonfunctioning adenomas.
• [68Ga]Ga-PentixaFor may be useful in the evaluation of adrenal adenomas in the setting of Conn's or Cushing's syndrome. Localizing functional adenomas is important for managing treatment options but current imaging modalities are either too invasive or insufficiently able to differentiate adrenal conditions.

Objective:

-To estimate the percent concordance of [68Ga]Ga-PentixaFor imaging with clinical diagnosis in identifying functional adrenal or extra-adrenal adenomas in hyperaldosteronism and hypercortisolism

Eligibility:

• Must have any of the following:

• one or more adrenal masses on CT and/or MRI and biochemical evidence of excess aldosterone or
• ACTH-independent hypercortisolism with or without adrenal masses on CT and/or MRI or
• history of ACTH-dependent hypercortisolism (with or without adrenal enlargement)
• Age >= 18 years
• ECOG performance status <= 2

Design:

• This is a Phase II, single site study where participants from three cohorts are enrolled into one arm according to their probable disease: primary aldosteronism (Cohort 1), ACTHindependent Cushing's syndrome (Cohort 2), or ACTH-dependent Cushing's syndrome (Cohort 3).
• All participants will undergo a [68Ga]Ga-PentixaFor PET/CT or [68Ga]Ga-PentixaFor PET/MR.
• A safety visit will be performed 3 days following the [68Ga]Ga-PentixaFor imaging.
• Participants will remain on-study for up to 1 year to allow the collection of samples for correlative analysis from the parent protocol (adrenal venous sampling, imaging assessments, laboratory evaluations, and/or tissue samples).

• INCLUSION CRITERIA:
• Must have any of the following:

• one or more adrenal masses on CT and/or MRI and biochemical evidence of excess aldosterone

OR

--ACTH-independent hypercortisolism, with or without adrenal masses on CT and/or MRI

OR

• history of ACTH-dependent hypercortisolism (with or without adrenal enlargement)
• Co-enrollment in 19-DK-0066, 09-C-0242, 18-CH-0031 or a similar NIH trial.
• Age >=18 years.
• ECOG performance status <= 2.
• Women of child-bearing potential (WOCBP) and men must agree to use an effective contraception (barrier, hormonal, intrauterine device [IUD], surgical sterilization, abstinence) for two weeks prior to [68Ga]Ga-PentixaFor scan and for one week after the [68Ga]Ga-PentixaFor scan.

• Breastfeeding should be discontinued for one week after the [68Ga]Ga-PentixaFor scan.
• Men must agree not to donate sperm for one week after the [68Ga]Ga-PentixaFor scan.
• Participants must be able to understand and willing to sign a written informed consent document.

Exclusion criteria

• Positive beta-human chorionic gonadotropin (beta-HCG) serum or urine pregnancy test performed in females of childbearing potential at screening.
• Uncontrolled intercurrent illness or social situations based on the review of medical history that would limit compliance with study requirements.
• Contraindications to having an MRI and CT.