Many clinicians who correspond with us at Thyroid Science ask if we will publish papers on adrenal dysfunctions. As these disorders are so often related to thyroid dysfunction, our answer has been yes. According to our communications, most clinicians find that their thyroid patients have cortisol deficiencies, yet others have unexplained elevated cortisol levels.

The patient of Evangelista et al. had elevated renin rather than cortisol. They found the source to be an adrenal cortical "incidentaloma." An incidentaloma is an unexpected finding of an adenoma during a diagnostic procedure performed to learn the source of a patient’s abdominal symptoms.

The authors performed adrenal scintigraphy using "NCL-6-I." NCL-6-I is a radioactive agent taken up by the adrenal glands some ten-times more than alternative agents.[1] By measuring its accumulation in the adrenal gland by scintigraphy, it functions as an effective radioactive tracer. Resulting scintigrams are the photographic record that indicates the intensity and distribution of radioactivity in parts of the adrenal glands after the diagnostician administers the radioactive tracer. The authors provide three such scintigrams. They note that adrenocortical radiocholesterol scintigraphy, in which they used NCL-6-I, is the most accurate non-invasive imaging technique in differentiating benign cortical adenomas from space-occupying or destructive adrenal lesions. They point out that the faint uptake of the tracer in the patient indicated an adrenal cortical adenoma.

We would especially like to note a precaution from the authors. That is, in the population at large, adrenal adenomas are fairly common, ranging between 2% and 9%. The authors emphasize the importance of the incidental detection of such adrenal lesions, especially for the patient with a previous malignancy.

This case report is one of the few published since 1996 on the value of adrenal scintigraphy with NCL-6-I. We are proud to add this case report to the literature on this tracer. We believe that knowledge of the diagnostic procedure will be of value to some clinicians trying to determine why some patients have high adrenocortical hormone levels—especially high cortisol levels not explained by common mechanisms such as pain, inflammation, glycemic dysregulation, or psychologically-induced stress.

Evangelista, L., Teresa De Falco, T., Carmine di Nuzzo, C., Salvatore, M.: Utility of adrenal cortical scintigraphy with ¹³¹I-6-β-Methyl-Norcholesterol in a case of mismatch between morphological and functional PET imaging. Thyroid Science, 3(6):CR1-3, 2008.