核醫NP-59腎上腺皮質檢查配合電腦斷層用以診斷庫辛症候群－病例報告

Iodocholesterol Scintigraphy (NP-59) in Cushing's Sydrome with Computed Tomography (CT) Correlation

黃政凱(Cheng-Kai Huang) ； 蔡世傳(Shih-Chung Tsai) ； 黃華思(Wallasce Huang) ； 鄭凱元(K-Y Cheng)

《中華放射線技術學雜誌》 29卷2期 (2005/12) Pp. 195-199

https://doi.org/10.30045/CJRT.200512.0011

摘要

一位47歲女性新陳代謝科門診患者因血糖濃度及血壓高，皮膚變薄、骨質疏鬆等症狀；生化檢查其血漿中皮質醇濃度(cortisol)為20 μg/dl、血漿中促腎上腺皮質激素濃度(ACTH)為3 pg/ml，之後安排放射科和核醫科檢查以評估是否為庫辛症候群(Cushing Syndrome)患者，電腦斷層檢查（民國91年11月）在使用顯影劑做腹部電腦斷層後發現在左側腎上腺有2.5 cm大的腫塊，且其邊緣定位明顯，放射科醫師認為可能為左側腎上腺腺瘤；之後做核醫NP-59腎上腺皮質檢查（民國92年1月）在注射NP-59三天後發現於腎上腺兩側腎上腺均有攝取，在左側腎上腺尤其明顯，核醫科醫師認為可能結果為左側腎上腺為腺瘤(adenoma)，右側腎上腺為增生(hyperplasia)，但仍不排除雙側腎上腺可能為腺瘤（不對稱性）或雙側腎上腺為增生（對稱性），外科手術將左側腎上腺切除送病理科檢查（民國92年2月），病理報告為皮質腺瘤(cortical adenoma)。

關鍵字

庫辛症候群 ； NP-59腎上腺皮質檢查 ； 腺瘤

並列摘要

Cushing's syndrome results from excessive glucocorticoid levels can be due to corticotrophin (ACTH) dependent or independent causes. The determination ACTH dependency is made biochemically. It is essential to determine whether cortisol hypersecretion is unilateral or bilateral, which side is the site of disease. Computed tomography (CT) is standard imaging tool used in the evaluation of anatomic abnormalities of adrenal gland. It can provide the size and location of the tumor. Iocholesterol Scintigraphy is a functional adrenal imaging study. Imaging of adrenal glands with NP-59 depends on the physiologic uptake of NP-59 in hyperfunction glands. NP-59 has been found to be accurate in identify the location and nature of adrenal dysfunction in ACTH-independent Cushing's syndrome with high overall sensitivity and specificity. CT scans have also been found to be accurate in localizing adrenal disease. Combine two scans can provide more useful information to help clinic diagnosis of adrenal glands disease.

並列關鍵字

Cushing Syndrome ； Iodocholesterol NP-59 scintigraphy ； adenoma ； hyperplasia ； ACTH