Molecular Imaging Targeting Corticotropin-releasing Hormone Receptor for Corticotropinoma: A Changing Paradigm

Author:

Walia Rama1ORCID,Gupta Rahul1ORCID,Bhansali Anil1,Pivonello Rosario2,Kumar Rajender3,Singh Harmandeep3,Ahuja Chirag4,Chhabra Rajesh5,Singh Apinderpreet5,Dhandapani Sivashanmugam5,Sahoo Sushant5,Rana Nivedita3,Vatsa Rakhee3,Dutta Pinaki1,Kumar Bhadada Sanjay1,Sachdeva Naresh1,Mittal B R3,Nahar Uma6,Shukla Jaya3

Affiliation:

1. Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

2. Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy

3. Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

4. Department of Radio-diagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India

5. Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

6. Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Abstract

Abstract Background Corticotrophin-releasing hormone (CRH) is the major regulator of adrenocorticotrophic hormone (ACTH) secretion from the anterior pituitary and acts via CRH-1 receptors (CRH-1R). Corticotropinoma though autonomous, still retain their responsiveness to CRH and hence, we hypothesize that in vivo detection of CRH-1 receptors on pituitary adenoma using Gallium-68 (68Ga)-tagged CRH can indicate the functionality of adenoma, and combining it with positron emission tomography-computed tomography (PET-CT) can provide requisite anatomical information. Methods Subjects with ACTH-dependent Cushing’s syndrome (CS) (n = 27, 24 with Cushing’s disease [CD], 3 with ectopic CS [ECS]) underwent 68Ga CRH PET-CT. Two nuclear medicine physicians read these images for adenoma delineation and superimposed them on magnetic resonance imaging (MRI) sella. The information provided was used for intraoperative navigation and compared with operative and histopathological findings. Findings 68Ga CRH PET-CT correctly delineated corticotropinoma in all the 24 cases of CD, including the 10 cases with adenoma size < 6mm (4 cases were negative on MRI). Corticotropinoma location on 68Ga CRH PET fusion images with MRI were concordant with operative findings and were further confirmed on histopathology. There was no tracer uptake in the pituitary in 2 patients with ECS, while, in another, the diffuse uptake in pituitary suggested ectopic CRH production. Conclusion 68Ga CRH PET-CT represents a novel, noninvasive molecular imaging, targeting CRH receptors that not only delineate corticotropinoma and provides the surgeon with valuable information for intraoperative tumor navigation, but also helps in differentiating a pituitary from an extra-pituitary source of ACTH-dependent CS. Funding None.

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

Reference15 articles.

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