Diagnostic Study

Primary aldosteronism (PA) affects 5-20% of all patients with hypertension, making it the most treatable cause of hypertension. While PA can be treated with mineralocorticoid-receptor antagonists, unilateral PA is curable with laparoscopic adrenalectomy. Identifying unilateral PA has been hitherto a challenge. Adrenal vein sampling (AVS) is required in almost all patients for subtyping PA, but AVS is also invasive and technically challenging, with success rates of ~30-60% in some centres, and ~80% in specialized centres. Functional imaging offers an alternative to AVS and coupled with high-resolution CT, 11C-Metomidate PET-CT can detect functional aldosterone-producing adenomas (APA) <1cm.  

Our nuclear medicine team has been collaborating with endocrinologists in a nationwide trial PA_CURE led by Principal Investigator Dr Troy Puar from CGH Department of  Endocrinology. This clinical trial produced the first ever published trial results in Asia Pacific regarding the clinical use of a novel PET tracer 11C-Metomidate to evaluate primary aldosteronism versus standard of care adrenal vein sampling and measure clinical outcomes for surgical cure. Nuclear medicine physicians and endocrinologists play key roles in furthering this line of research and translation into clinical practice with surgical cures for patients. This study was funded by National Medical Research Council (NMRC), Singapore. R.S. Foo was supported by NMRC, Singapore and A*Star Biomedical Research Council. T.H. Puar was supported by the NMRC Research Training Fellowship award, Singapore.

Contact: Please contact Dr Tong Kian Ti Aaron at aaron.tong.k.t@singhealth.com.sg. for more information.

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Given the rapidly aging population in Singapore, the health and economic burden of osteoporosis and its related fractures has become a major public health issue. Areal BMD measured by DXA is considered as the gold standard for diagnosis of osteoporosis and has a major role in fracture risk assessment.  However, it is increasingly being recognised that the ability of a bone to resist fracture depends not only on bone mass, but also bone geometry, cortical thickness, trabecular bone morphology and the intrinsic properties of bone tissue.  We have recently acquired two software programs: TBS iNsight™ that computes a Trabecular Bone Score from the DXA lumbar spine image, and 3D-Shaper® that analyses cortical and trabecular bone from the DXA image of the hip, and we are in collaboration with our clinical colleagues to study the potential in improving the fracture discriminating capability of DXA beyond BMD.  

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