Case Report: Five positive lesions on bilateral adrenal glands detected by a single 68Ga-pentixafor PET/CT

Background Primary aldosteronism (PA) is an endocrine disorder caused by autonomous aldosterone hypersecretion from the adrenal zona glomerulosa, causing sodium retention, plasma volume expansion, and suppressed renin activity, manifesting as hypertension with/without hypokalemia. Aldosterone-producing adenomas (APAs), a common PA subtype, are typically unilateral and solitary; bilateral involvement is rare. We report a patient with hypertension and bilateral multiple adrenal adenomas. 68 Ga-Pentixafor PET/CT proved crucial for detecting and subtyping lesions, highlighting its significant diagnostic utility for APA subtyping. Case presentation A 62-year-old male presenting with nausea, generalized fatigue, and poorly controlled hypertension (10-year history; max BP 200/110 mmHg) was admitted. Bilateral adrenal CT, which revealed multiple bilateral adrenal adenomas, raised clinical suspicion for primary aldosteronism. To confirm the diagnosis, 68 Ga-Pentixafor PET/CT imaging was performed, which identified five nodules with varying intensities of tracer uptake bilaterally. Conclusion 68 Ga-Pentixafor PET/CT integrates structural and functional assessment, transcending the limitations of CT and adrenal vein sampling (AVS), thereby demonstrating substantial clinical value for evaluating multifocal or bilateral adrenal pathologies.