Pub Date : 2017-01-01Epub Date: 2017-02-28DOI: 10.1159/000452902
Adriana Del Rey, Hugo O Besedovsky
The existence of a network of interactions between the immune and nervous systems that influences host defenses and brain functions is now well-established. Here we discuss how immune and classical neuro/sensorial signals are processed in the brain and how neuro-endocrine immunoregulatory and behavioral responses are integrated. Considering the ability of brain cells to produce cytokines, originally described as immune cell products, we propose that the tripartite synapse plays a central role in the integration of neuro-endocrine-immune interactions. We also propose that the immune-neuro-endocrine responses that influence the course of transmissible and other diseases predisposing to infections can be relevant for evolution, either by restoring health or by mediating an active process of negative selection.
{"title":"Immune-Neuro-Endocrine Reflexes, Circuits, and Networks: Physiologic and Evolutionary Implications.","authors":"Adriana Del Rey, Hugo O Besedovsky","doi":"10.1159/000452902","DOIUrl":"https://doi.org/10.1159/000452902","url":null,"abstract":"<p><p>The existence of a network of interactions between the immune and nervous systems that influences host defenses and brain functions is now well-established. Here we discuss how immune and classical neuro/sensorial signals are processed in the brain and how neuro-endocrine immunoregulatory and behavioral responses are integrated. Considering the ability of brain cells to produce cytokines, originally described as immune cell products, we propose that the tripartite synapse plays a central role in the integration of neuro-endocrine-immune interactions. We also propose that the immune-neuro-endocrine responses that influence the course of transmissible and other diseases predisposing to infections can be relevant for evolution, either by restoring health or by mediating an active process of negative selection.</p>","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"48 ","pages":"1-18"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000452902","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34771222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-02-28DOI: 10.1159/000452904
U Renner, M Sapochnik, K Lucia, G K Stalla, E Arzt
Endotoxin (lipopolysaccharide, LPS) of gram-negative bacteria has been recognized for more than 40 years as a modulator of anterior pituitary hormone production. The action of LPS was thought to be predominantly mediated through LPS-stimulated immune cell-derived cytokines, and is part of the concept of immune-endocrine crosstalk, which regulates bidirectional adaptive processes between the endocrine and immune systems during inflammatory or infectious processes. With the detection of innate immune system components in the normal and tumoral pituitary, including the Toll-like receptor 4, the target of LPS, it has become evident that LPS can directly modify the physiology and pathophysiology of the anterior pituitary. LPS-induced intrapituitary mechanisms involve the stimulation of intrapituitary cytokines, and also directly act on hormone synthesis, growth, and apoptosis of endocrine cells. This review focuses on the effects of LPS on pituitary physiology, its interaction with pro- and anti-inflammatory factors, and the molecular mechanisms involved in these processes.
{"title":"Intrahypophyseal Immune-Endocrine Interactions: Endocrine Integration of the Inflammatory Inputs.","authors":"U Renner, M Sapochnik, K Lucia, G K Stalla, E Arzt","doi":"10.1159/000452904","DOIUrl":"https://doi.org/10.1159/000452904","url":null,"abstract":"<p><p>Endotoxin (lipopolysaccharide, LPS) of gram-negative bacteria has been recognized for more than 40 years as a modulator of anterior pituitary hormone production. The action of LPS was thought to be predominantly mediated through LPS-stimulated immune cell-derived cytokines, and is part of the concept of immune-endocrine crosstalk, which regulates bidirectional adaptive processes between the endocrine and immune systems during inflammatory or infectious processes. With the detection of innate immune system components in the normal and tumoral pituitary, including the Toll-like receptor 4, the target of LPS, it has become evident that LPS can directly modify the physiology and pathophysiology of the anterior pituitary. LPS-induced intrapituitary mechanisms involve the stimulation of intrapituitary cytokines, and also directly act on hormone synthesis, growth, and apoptosis of endocrine cells. This review focuses on the effects of LPS on pituitary physiology, its interaction with pro- and anti-inflammatory factors, and the molecular mechanisms involved in these processes.</p>","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"48 ","pages":"37-47"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000452904","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34771161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pituitary autoimmunity, considered a synonym of autoimmune hypophysitis, defines a wide spectrum of conditions (neoplastic, functional, and iatrogenic pituitary disorders; and extra-pituitary autoimmune and non-autoimmune diseases), and is characterized by the presence of antipituitary antibodies (APAs) at various titer and prevalence. These conditions have been increasingly recognized not only in adults, but also in children. The autoimmune pathogenesis, histological features of the primary (i.e. lymphocytic, granulomatous, xanthomatous, IgG-4 related lymphoplasmacytic, and necrotizing) forms, and the pathognomonic association of lymphocytic hypophysitis with pregnancy and CTLA-4 antibody therapy, have been clearly demonstrated. Meanwhile, non-invasive differential diagnosis remains extremely challenging since none of the suggested clinical, radiological or laboratory criteria are pathognomonic. In this context, the demonstration of APA is not sufficient, because of the lack of specificity, and associated methodological and theoretical issues (i.e. disease marker vs. pathogen; antigen target(s); and diagnostic/prognostic significance). This chapter aims at providing a comprehensive overview of the pituitary autoimmunity panorama for epidemiological, clinical radiological, and histological aspects, while discussing the main diagnostic limitations and issues associated with disease management.
{"title":"Pituitary Autoimmunity.","authors":"Federica Guaraldi, Roberta Giordano, Silvia Grottoli, Lucia Ghizzoni, Emanuela Arvat, Ezio Ghigo","doi":"10.1159/000452905","DOIUrl":"https://doi.org/10.1159/000452905","url":null,"abstract":"<p><p>Pituitary autoimmunity, considered a synonym of autoimmune hypophysitis, defines a wide spectrum of conditions (neoplastic, functional, and iatrogenic pituitary disorders; and extra-pituitary autoimmune and non-autoimmune diseases), and is characterized by the presence of antipituitary antibodies (APAs) at various titer and prevalence. These conditions have been increasingly recognized not only in adults, but also in children. The autoimmune pathogenesis, histological features of the primary (i.e. lymphocytic, granulomatous, xanthomatous, IgG-4 related lymphoplasmacytic, and necrotizing) forms, and the pathognomonic association of lymphocytic hypophysitis with pregnancy and CTLA-4 antibody therapy, have been clearly demonstrated. Meanwhile, non-invasive differential diagnosis remains extremely challenging since none of the suggested clinical, radiological or laboratory criteria are pathognomonic. In this context, the demonstration of APA is not sufficient, because of the lack of specificity, and associated methodological and theoretical issues (i.e. disease marker vs. pathogen; antigen target(s); and diagnostic/prognostic significance). This chapter aims at providing a comprehensive overview of the pituitary autoimmunity panorama for epidemiological, clinical radiological, and histological aspects, while discussing the main diagnostic limitations and issues associated with disease management.</p>","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"48 ","pages":"48-68"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000452905","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34771162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01Epub Date: 2017-02-28DOI: 10.1159/000452908
Nathalia R V Dragano, Roberta Haddad-Tovolli, Licio A Velloso
Hypothalamic resistance to adipostatic actions of leptin is a hallmark of obesity. Studies have revealed that hypothalamic inflammation, triggered in response to the consumption of large amounts of dietary fat, is an important mechanism in the development of leptin resistance. In this chapter, we will review the work that paved the way linking neuroinflammation of the hypothalamus and defective leptin action in obesity.
{"title":"Leptin, Neuroinflammation and Obesity.","authors":"Nathalia R V Dragano, Roberta Haddad-Tovolli, Licio A Velloso","doi":"10.1159/000452908","DOIUrl":"https://doi.org/10.1159/000452908","url":null,"abstract":"<p><p>Hypothalamic resistance to adipostatic actions of leptin is a hallmark of obesity. Studies have revealed that hypothalamic inflammation, triggered in response to the consumption of large amounts of dietary fat, is an important mechanism in the development of leptin resistance. In this chapter, we will review the work that paved the way linking neuroinflammation of the hypothalamus and defective leptin action in obesity.</p>","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"48 ","pages":"84-96"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000452908","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34771165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ultrasound (US) is the most widely available method of diagnostic imaging for the evaluation and characterization of gonadal lesions and is usually the method of choice because of its high accuracy, low cost and wide availability. Today's high-resolution images allow for a confident diagnosis of many scrotal and adnexal lesions, with high sensitivity and specificity. Magnetic resonance imaging (MRI) is reliable in the detection of gonadal lesions in males, allowing the differentiation into testicular or nontesticular lesions, and their characterization. It is also an accurate and cost-effective diagnostic adjunct in those patients with solid scrotal lesions for whom the findings of clinical and US evaluations are inconclusive. In females, MRI is recommended as a second-line investigation for the characterization of complex adnexal masses that are indeterminate on US. In this review, gonadal pathologies related with the steroidogenic and gametogenic function of the testes and ovaries will be discussed. The main imaging features of benign and malignant lesions will also be presented.
{"title":"Gonadal Imaging in Endocrine Disorders.","authors":"F. Lanfranco, G. Motta","doi":"10.1159/000442319","DOIUrl":"https://doi.org/10.1159/000442319","url":null,"abstract":"Ultrasound (US) is the most widely available method of diagnostic imaging for the evaluation and characterization of gonadal lesions and is usually the method of choice because of its high accuracy, low cost and wide availability. Today's high-resolution images allow for a confident diagnosis of many scrotal and adnexal lesions, with high sensitivity and specificity. Magnetic resonance imaging (MRI) is reliable in the detection of gonadal lesions in males, allowing the differentiation into testicular or nontesticular lesions, and their characterization. It is also an accurate and cost-effective diagnostic adjunct in those patients with solid scrotal lesions for whom the findings of clinical and US evaluations are inconclusive. In females, MRI is recommended as a second-line investigation for the characterization of complex adnexal masses that are indeterminate on US. In this review, gonadal pathologies related with the steroidogenic and gametogenic function of the testes and ovaries will be discussed. The main imaging features of benign and malignant lesions will also be presented.","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"45 1","pages":"80-96"},"PeriodicalIF":0.0,"publicationDate":"2016-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64972411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic ultrasound (EUS) imaging of adrenal glands and its application to diagnostic procedures of adrenal diseases has been reported since 1998. It can be considered a relevant advantage in the field of adrenal diseases. Indeed, EUS allows the detection of adrenal lesions (even very small ones) and their characterization, the assessment of malignancy criteria, the early detection of neoplastic recurrences, the preoperative identification of morphologically healthy parts of the glands, the differentiation of extra-adrenal from adrenal tumors, and of the pathological entities associated with adrenal insufficiency, and the fine-needle aspiration biopsy (EUS-FNA) of suspicious lesions. At the same time, its clinical relevance depends on the experience of the endosonographer. Moreover, EUS is also by far the best and most sensitive imaging technique to detect and assess the follow-up of pancreatic manifestation of MEN1 disease. It furthermore enables the preoperatively localization of insulinomas and critical structures in their neighborhood, and may be relevant in planning surgical strategy. A positive EUS in a case of insulinoma furthermore confirms the endocrine diagnosis, especially considering the differential diagnosis of hypoglycemia factitia by oral antidiabetics. It can be supplemented by EUS-FNA. Again, it has to be considered that EUS may reveal false positive and false negative results, and the quality of the findings largely depends on the endosonographer's skills and experience. The most important technical details together with the advantages and limitations of EUS, and the pathognomonic characteristic of benign and malignant disorders of the adrenals and pancreas are presented here.
{"title":"Endoscopic Ultrasound in Endocrinology: Imaging of the Adrenals and the Endocrine Pancreas.","authors":"P. Kann","doi":"10.1159/000442277","DOIUrl":"https://doi.org/10.1159/000442277","url":null,"abstract":"Endoscopic ultrasound (EUS) imaging of adrenal glands and its application to diagnostic procedures of adrenal diseases has been reported since 1998. It can be considered a relevant advantage in the field of adrenal diseases. Indeed, EUS allows the detection of adrenal lesions (even very small ones) and their characterization, the assessment of malignancy criteria, the early detection of neoplastic recurrences, the preoperative identification of morphologically healthy parts of the glands, the differentiation of extra-adrenal from adrenal tumors, and of the pathological entities associated with adrenal insufficiency, and the fine-needle aspiration biopsy (EUS-FNA) of suspicious lesions. At the same time, its clinical relevance depends on the experience of the endosonographer. Moreover, EUS is also by far the best and most sensitive imaging technique to detect and assess the follow-up of pancreatic manifestation of MEN1 disease. It furthermore enables the preoperatively localization of insulinomas and critical structures in their neighborhood, and may be relevant in planning surgical strategy. A positive EUS in a case of insulinoma furthermore confirms the endocrine diagnosis, especially considering the differential diagnosis of hypoglycemia factitia by oral antidiabetics. It can be supplemented by EUS-FNA. Again, it has to be considered that EUS may reveal false positive and false negative results, and the quality of the findings largely depends on the endosonographer's skills and experience. The most important technical details together with the advantages and limitations of EUS, and the pathognomonic characteristic of benign and malignant disorders of the adrenals and pancreas are presented here.","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"45 1","pages":"46-54"},"PeriodicalIF":0.0,"publicationDate":"2016-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64970077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A deep understanding of thyroid pathophysiology is the basis for diagnosing and treating benign thyroid diseases with radioactive materials, known as radiopharmaceuticals, which are introduced into the body by injection or orally. After the radiotracer administration, the patient becomes the emitting source, and several devices have been studied to detect and capture these emissions (gamma or beta-negative) and transform them into photons, parametric images, numbers and molecular information. Thyroid scintigraphy is the only technique that allows the assessment of thyroid regional function and, therefore, the detection of areas of autonomously functioning thyroid nodules. Scintigraphy visualizes the distribution of active thyroid tissue and displays the differential accumulation of radionuclides in the investigated cells, thus providing a functional map. Moreover, this technique is a fundamental tool in the clinical and surgical management of thyroid diseases, including: single thyroid nodules with a suppressed thyroid-stimulating hormone level, for which fine-needle aspiration biopsy (FNAB) is used to identify hot nodules; multinodular goiters, especially larger ones, to identify cold or indeterminate areas requiring FNAB and hot areas that do not need cytologic evaluation, and to evaluate mediastinal extension; the diagnosis of ectopic thyroid tissue; subclinical hyperthyroidism to identify occult hyperfunctioning tissue; follicular lesions to identify a functioning cellular adenoma that could be benign, although such nodules are mostly cold on scintigraphy; to distinguish low-uptake from high-uptake thyrotoxicosis, and to determine eligibility for radioiodine therapy.
{"title":"Role of Nuclear Medicine in the Diagnosis of Benign Thyroid Diseases.","authors":"Sara Garberoglio, O. Testori","doi":"10.1159/000442275","DOIUrl":"https://doi.org/10.1159/000442275","url":null,"abstract":"A deep understanding of thyroid pathophysiology is the basis for diagnosing and treating benign thyroid diseases with radioactive materials, known as radiopharmaceuticals, which are introduced into the body by injection or orally. After the radiotracer administration, the patient becomes the emitting source, and several devices have been studied to detect and capture these emissions (gamma or beta-negative) and transform them into photons, parametric images, numbers and molecular information. Thyroid scintigraphy is the only technique that allows the assessment of thyroid regional function and, therefore, the detection of areas of autonomously functioning thyroid nodules. Scintigraphy visualizes the distribution of active thyroid tissue and displays the differential accumulation of radionuclides in the investigated cells, thus providing a functional map. Moreover, this technique is a fundamental tool in the clinical and surgical management of thyroid diseases, including: single thyroid nodules with a suppressed thyroid-stimulating hormone level, for which fine-needle aspiration biopsy (FNAB) is used to identify hot nodules; multinodular goiters, especially larger ones, to identify cold or indeterminate areas requiring FNAB and hot areas that do not need cytologic evaluation, and to evaluate mediastinal extension; the diagnosis of ectopic thyroid tissue; subclinical hyperthyroidism to identify occult hyperfunctioning tissue; follicular lesions to identify a functioning cellular adenoma that could be benign, although such nodules are mostly cold on scintigraphy; to distinguish low-uptake from high-uptake thyrotoxicosis, and to determine eligibility for radioiodine therapy.","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"45 1","pages":"24-36"},"PeriodicalIF":0.0,"publicationDate":"2016-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64969849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The presence of large numbers and/or the high affinity of dopamine D2 and/or somatostatin receptors on pituitary adenomas may enable their visualization with radionuclide-coupled receptor agonists or antagonists. However, the role of these imaging modalities in the differential diagnosis of or therapeutic purposes for pituitary lesions is very limited. Only in very specific cases might these molecular imaging techniques become helpful. These include the differential diagnosis of pituitary lesions, ectopic production of pituitary hormones, such as adrenocorticotrophic hormone, growth hormone (GH) or their releasing hormones (corticotropin-releasing hormone and GH-releasing hormone), and the localization of metastases from pituitary carcinomas.
{"title":"Molecular Imaging of Pituitary Pathology.","authors":"Wouter W de Herder","doi":"10.1159/000442329","DOIUrl":"https://doi.org/10.1159/000442329","url":null,"abstract":"The presence of large numbers and/or the high affinity of dopamine D2 and/or somatostatin receptors on pituitary adenomas may enable their visualization with radionuclide-coupled receptor agonists or antagonists. However, the role of these imaging modalities in the differential diagnosis of or therapeutic purposes for pituitary lesions is very limited. Only in very specific cases might these molecular imaging techniques become helpful. These include the differential diagnosis of pituitary lesions, ectopic production of pituitary hormones, such as adrenocorticotrophic hormone, growth hormone (GH) or their releasing hormones (corticotropin-releasing hormone and GH-releasing hormone), and the localization of metastases from pituitary carcinomas.","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"45 1","pages":"133-41"},"PeriodicalIF":0.0,"publicationDate":"2016-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64972688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radioactive isotopes of radioiodine are frequently used in differentiated thyroid carcinoma (DTC) both for diagnosis and therapy. Their accumulation in thyroid cancer tissue is dependent on the expression and activity of the sodium-iodide symporter (NIS). Scintigraphic imaging using either planar or single-photon emission computed tomography (SPECT) cameras allows the visualization of their distribution within the human body. Due to only a poor visualization of morphology by these techniques, their diagnostic accuracy is, however, limited. This limitation is overcome when hybrid systems integrating a SPECT camera with an X-ray CT scanner are used. Roughly one third of patients with diagnostically unclear foci of radioiodine accumulation will benefit from the use of SPECT/CT, also in terms of therapeutic management. SPECT/CT has, therefore, become the gold standard of nuclear imaging in DTC. NIS expression may be absent in DTC. In this case, the glucose transporters are usually upregulated. Therefore, PET/CT using 18F-deoxyglucose can be used to diagnose and localize tumor recurrence as a prerequisite to, in particular, surgical intervention.
{"title":"Hybrid Molecular Imaging in Differentiated Thyroid Carcinoma.","authors":"D. Schmidt, T. Kuwert","doi":"10.1159/000442276","DOIUrl":"https://doi.org/10.1159/000442276","url":null,"abstract":"Radioactive isotopes of radioiodine are frequently used in differentiated thyroid carcinoma (DTC) both for diagnosis and therapy. Their accumulation in thyroid cancer tissue is dependent on the expression and activity of the sodium-iodide symporter (NIS). Scintigraphic imaging using either planar or single-photon emission computed tomography (SPECT) cameras allows the visualization of their distribution within the human body. Due to only a poor visualization of morphology by these techniques, their diagnostic accuracy is, however, limited. This limitation is overcome when hybrid systems integrating a SPECT camera with an X-ray CT scanner are used. Roughly one third of patients with diagnostically unclear foci of radioiodine accumulation will benefit from the use of SPECT/CT, also in terms of therapeutic management. SPECT/CT has, therefore, become the gold standard of nuclear imaging in DTC. NIS expression may be absent in DTC. In this case, the glucose transporters are usually upregulated. Therefore, PET/CT using 18F-deoxyglucose can be used to diagnose and localize tumor recurrence as a prerequisite to, in particular, surgical intervention.","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"45 1","pages":"37-45"},"PeriodicalIF":0.0,"publicationDate":"2016-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64970002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The major workload in the field of adrenal imaging comprises patients with adrenal tumors incidentally depicted by imaging performed for other reasons than adrenal disease. These so-called 'incidentalomas' are generally managed by CT and MRI, and molecular imaging techniques are required only for a few patients. PET/CT with 18F-fluorodeoxyglucose (18F-FDG) is useful for establishing whether an adrenal metastasis is the only lesion, and therefore is available for surgical resection, or if the disease is disseminated. 18F-FDG PET/CT may be applied to differ benign from malignant incidentalomas and can be helpful in the imaging of pheochromocytoma and adrenocortical cancer (ACC). 11C-metomidate PET/CT can differentiate adrenocortical from nonadrenocortical tumors and a suspected ACC may be characterized and staged before surgery. 11C-metomidate PET/CT is currently also used to help diagnose Conn's adenomas in primary aldosteronism, but further development is needed. Scintigraphy with 123I/131I-metaiodobenzylguanidine (MIBG) remains the mainstay for molecular imaging of pheochromocytoma and is mandatory in patients for whom 131I-MIBG therapy is considered. A PET tracer for the imaging of pheochromocytoma is the norepinephrine analogue (11)C-hydroxyephedrine that can be used to characterize equivocal lesions and for the follow-up and diagnosis of recurrent malignant disease. Other specialized PET tracers for the imaging of pheochromocytoma are 18F-fluorodihydroxyphenylalanine (18F-DOPA) and 18F-fluorodopamine.
{"title":"Adrenal Molecular Imaging.","authors":"A. Sundin","doi":"10.1159/000442317","DOIUrl":"https://doi.org/10.1159/000442317","url":null,"abstract":"The major workload in the field of adrenal imaging comprises patients with adrenal tumors incidentally depicted by imaging performed for other reasons than adrenal disease. These so-called 'incidentalomas' are generally managed by CT and MRI, and molecular imaging techniques are required only for a few patients. PET/CT with 18F-fluorodeoxyglucose (18F-FDG) is useful for establishing whether an adrenal metastasis is the only lesion, and therefore is available for surgical resection, or if the disease is disseminated. 18F-FDG PET/CT may be applied to differ benign from malignant incidentalomas and can be helpful in the imaging of pheochromocytoma and adrenocortical cancer (ACC). 11C-metomidate PET/CT can differentiate adrenocortical from nonadrenocortical tumors and a suspected ACC may be characterized and staged before surgery. 11C-metomidate PET/CT is currently also used to help diagnose Conn's adenomas in primary aldosteronism, but further development is needed. Scintigraphy with 123I/131I-metaiodobenzylguanidine (MIBG) remains the mainstay for molecular imaging of pheochromocytoma and is mandatory in patients for whom 131I-MIBG therapy is considered. A PET tracer for the imaging of pheochromocytoma is the norepinephrine analogue (11)C-hydroxyephedrine that can be used to characterize equivocal lesions and for the follow-up and diagnosis of recurrent malignant disease. Other specialized PET tracers for the imaging of pheochromocytoma are 18F-fluorodihydroxyphenylalanine (18F-DOPA) and 18F-fluorodopamine.","PeriodicalId":50428,"journal":{"name":"Frontiers of Hormone Research","volume":"45 1","pages":"70-9"},"PeriodicalIF":0.0,"publicationDate":"2016-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64972385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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