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68Ga-Pentixafor PET/CT complements AVS deficiencies in bilateral aldosterone-producing adenomas: Lessons from unexpected sequential partial adrenalectomy

Journal of Human Hypertension volume 40, pages 342–344 (2026) Cite this article

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The patient was re-evaluated three months postoperative, revealing severe hypokalemia (2.23 mmol/L), elevated ALD (1653 pmol/L), low DRC (3.35 mU/L), high ARR (493.52 (pmol/L)/(mU/L)), and persistent hypertension (SBP 170-180 mmHg), indicating absent biochemical and clinical success. Repeat adrenal CT demonstrates post-operative changes and a recurrent nodule in the left side (left: 12 mm; right: 16 mm) (Fig. 1B). To determine the next treatment planning, we discussed the patient’s condition and the available options. The patient requested a 68Ga-pentixafor PET/CT scan rather than a repeated invasive AVS examination. It revealed lower C-X-C chemokine receptor 4 (CXCR4) uptake on the left (SUVmax 2.2) compared to intense uptake on the right (SUVmax 19.8), leading to the decision for a right partial adrenalectomy instead of a left total adrenalectomy (Fig. 1C, D). Histopathology confirmed an APA with positive CYP11B2 staining. At three-month follow-up, the patient achieved normotension without medication, potassium normalized (4.08 mmol/L), and biochemical parameters improved (ALD 141 pmol/L, DRC 24.98 mU/L, ARR 5.66 (pmol/L)/(mU/L)), confirming complete biochemical and clinical success without adrenal insufficiency.

PA refers to a clinical syndrome characterized by autonomous and excessive secretion of ALD, leading primarily to hypertension, hypokalemia, suppressed plasma renin activity, and alkalosis. Compared to patients with primary hypertension, those with PA experience more severe damage to target organs such as the heart and kidneys due to chronic exposure to elevated ALD levels [2,3,4,5]. Therefore, timely diagnosis and implementation of appropriate treatment strategies are essential to mitigate aldosterone-specific target organ injury. Currently, PA is clinically classified into unilateral and bilateral forms according to disease lateralization, which is central to therapeutic decision-making [1, 6, 7]. Unilateral PA is most often caused by an aldosterone-producing adenoma (APA), whereas bilateral PA comprises heterogeneous patterns of aldosterone overproduction. In recent years, increasing recognition of complex phenotypes, including bilateral or multifocal aldosterone-producing lesions, has made accurate subtype classification and clinical management more challenging.

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Fig. 1: Imaging examination of the patient who underwent a redo partial adrenalectomy.
The alternative text for this image may have been generated using AI.

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Acknowledgements

This study was funded by National Natural Science Foundation of China (82273121), Hunan Natural Science Foundation (2022JJ20096, 2024JJ5612). The authors thank urological surgeons, nurses, pathologists, and nuclear medicine physicians at Xiangya Hospital, Central South University for their efforts in gathering data for this study.

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  1. These authors contributed equally: Yi Yang, Kai Cheng.

Authors and Affiliations

  1. Department of Urology, Xiangya Hospital, Central South University, Changsha, China

    Yi Yang, Kai Cheng, Yao He, Longfei Liu & Yu Gan

  2. Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China

    Tingting Long

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  1. Yi Yang
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Contributions

YY and KC wrote original draft, collected the clinical data, and revised the manuscript. TL has contributed to the PET/CT imaging collection and analysis. YH, LL and YG reviewed all the information on the clinical case and checked the correctness of the data. All authors approved the final manuscript.

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Correspondence to Yao He, Longfei Liu or Yu Gan.

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Yang, Y., Cheng, K., Long, T. et al. 68Ga-Pentixafor PET/CT complements AVS deficiencies in bilateral aldosterone-producing adenomas: Lessons from unexpected sequential partial adrenalectomy. J Hum Hypertens 40, 342–344 (2026). https://doi.org/10.1038/s41371-026-01131-y

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