PET Tracer Localizes Overactive Adrenal Glands in Primary Aldosteronism

Primary aldosteronism (Conn’s syndrome) is the leading cause of curable secondary hypertension and results from excess aldosterone produced by the adrenal cortex. Determining whether hormone overproduction arises from one or both adrenal glands often requires adrenal vein sampling, an invasive procedure limited to specialized centers. Access barriers can delay targeted therapy and expose patients to procedural risk. A new first-in-human study has validated a positron emission tomography (PET) radiotracer that aims to localize overactive adrenal tissue noninvasively.

The investigational agent, carbon-11–labeled nevanimibe ([11C]Nevanimibe), was evaluated by researchers at the University of Michigan (Ann Arbor, MI, USA). The radiotracer targets cholesterol metabolism within adrenal tissue to visualize hormonally overactive glands on PET imaging. Findings were presented at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) 2026 Annual Meeting, held May 30 to June 2 in Los Angeles, where the approach was highlighted as a potential alternative to invasive diagnostic localization for primary aldosteronism.

In the first-in-human study, nine participants underwent PET imaging with [11C]Nevanimibe, including six healthy controls and three individuals previously diagnosed with overactive adrenal glands. Investigators compared maximum standardized uptake values in the adrenal glands and liver between affected patients and healthy subjects. Patients with adrenal pathology showed a higher mean adrenal-to-liver uptake ratio of 1.2 versus 0.7 in controls, and the human biodistribution of [11C]Nevanimibe closely mirrored preclinical findings, supporting translation toward clinical use.

The imaging strategy is intended to identify whether aldosterone overproduction is unilateral or bilateral, which guides definitive therapy. As reported, the technique offers an alternative to adrenal vein sampling by providing a noninvasive localization method that could help clinicians tailor treatment plans for primary aldosteronism. The work was shared as Abstract 261581, titled “First-in-human PET imaging of cholesterol trafficking in overactive adrenal glands with [11C]Nevanimibe.”

“One overactive adrenal gland can be removed to cure the overproduction, but if the overproduction is in both glands, patients require lifetime medication management. By using a PET radiotracer that targets cholesterol metabolism in the adrenal glands, physicians can noninvasively identify overactive glands to guide clinical decision-making,” said Peter Scott, Ph.D., Paul L. Carson, Ph.D., Legacy Professor of Radiology at the University of Michigan in Ann Arbor.

“This work further expands molecular imaging to benefit a population of patients currently lacking in non-invasive accessible diagnostic techniques. Additional clinical studies are underway to study dosimetry and efficacy of this tracer,” said Gina Kaup, graduate student in medicinal chemistry at the University of Michigan.

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