Characterization of adrenocortical tumors by 18 F-FDG PET/CT: Does steroid hormone hypersecretion status modify the uptake pattern?

Surg Oncol. 2018 Jun;27(2):231-235. doi: 10.1016/j.suronc.2018.04.003. Epub 2018 Apr 23.


Background: adrenal tumor-to-liver uptake value (Tmx:Lmx) on 18F-FDG PET/CT is an accurate and reproducible PET parameter in the distinction between benign and malignant adrenal masses. The potential impact of steroid hormone secretion on 18F-FDG uptake is still debatable. The aim of this study was to evaluate this relationship.

Methods: 2010-2015: 73 patients who underwent adrenalectomy for adrenocortical tumors [49 secreting/(SA) and 24 non-secreting/(NSA)] were retrospectively included in the study. Fourteen were malignant. All patients underwent hormonal evaluation, functional and anatomical imaging, Weiss scoring and Ki 67 evaluation.

Results: malignant tumors exhibit higher SUVmax than benign tumors (median 7.75 vs 3.06 respectively, p < 0.001) and Tmx:Lmx was 2.7 vs 1.17 for benign tumors, p < 0.001. Tmx:Lmx was positively correlated to Weiss score (p < 0.001). No significant difference was observed for Tmx:Lmx between SA and NSA overall (p = 0.851), regardless of the subgroup of tumors analyzed. Tmx:Lmx was not correlated to tumor size (p < 0.508) or 24 h free urinary cortisol level (p < 0.522).

Conclusions: no correlation was observed between Tmx:Lmx and hormonal status, however the correlation between ratio, malignancy and Weiss score confirm the utility of 18F-FDG PET/CT for the differentiation of benign from malignant adrenal lesions, irrespective of the hormone secretory status of the tumor. 18F-FDG PET/CT is a useful biomarker in the diagnosis of adrenal tumors, regardless of the secretion status.

Keywords: (18)F-FDG PET/CT; Adrenal masses; Hormone secretion.

MeSH terms

  • Adolescent
  • Adrenal Cortex Neoplasms / diagnostic imaging
  • Adrenal Cortex Neoplasms / metabolism*
  • Adrenal Cortex Neoplasms / pathology
  • Adrenal Cortex Neoplasms / surgery
  • Adrenal Gland Neoplasms / diagnostic imaging
  • Adrenal Gland Neoplasms / metabolism*
  • Adrenal Gland Neoplasms / pathology
  • Adrenal Gland Neoplasms / surgery
  • Adrenalectomy
  • Adult
  • Aged
  • Female
  • Fluorodeoxyglucose F18 / metabolism*
  • Follow-Up Studies
  • Gonadal Steroid Hormones / metabolism*
  • Humans
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography / methods*
  • Prognosis
  • Radiopharmaceuticals / metabolism
  • Retrospective Studies
  • Young Adult


  • Gonadal Steroid Hormones
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18