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Part VII. The Adrenal Connection in Neuroimmunoendocrinology |
PheochromocytomaPhysiopathologic Implications and Diagnostic Evaluation
EVANGELIA ZAPANTIa AND
IOANNIS ILIASb
a First Department of Endocrinology, Alexandra Hospital, Athens GR-11528, Greece b Department of Pharmacology, Medical School, University of Patras, Rion GR-26504, Greece
Key Words: pheochromocytoma • catecholamines • pathophysiology • insulin resistance • intra-adrenal • CRH • cytokines • computed tomography • magnetic resonance imaging • radionuclide imaging • octreotide • fluorine radioisotopes • positron emission tomography
Address for correspondence: Evangelia Zapanti, 8 Saki Karagiorga, Glyfada, 16675, Athens, Greece. e-mail: liazapanti@yahoo.gr
Pheochromocytoma (PHEO) is a chromaffin cell tumor embryologically arising from the neural crest tissue. The dominant secretory products of PHEO are catecholamines: noradrenaline (norepinephrine), adrenaline (epinephrine), and to a lesser extent dopamine. In addition to catecholamines, PHEO cells also elaborate and release several neuropeptides and inflammatory cytokines which can exert intra-adrenal and extra-adrenal systemic effects and cause characteristic clinical syndromes. In a concise review we present the intra-adrenal and extra-adrenal pathophysiologic implications of PHEO and the nuclear medicine modalities that permit functional imaging of physiological processes and help localize these tumors. The specific pathways of synthesis, metabolism, and inactivation of catecholamines (of PHEOs and paragangliomas) can be used as means to develop suitable tracers for positron emission tomography (PET) ligands. In this review we focus on imaging with PET using [18F]-fluorodopamine, [18F]-fluorohydroxyphenylalanine, [11C]-epinephrine, or [11C]-hydroxyephedrine and examine how functional imaging can often complement traditional anatomical imaging modalities and other scintigraphic techniques.
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