68Ga-Pentixafor PET/CT as a Noninvasive Alternative in Evaluation of Suspected Aldosterone-producing Adenoma

A 54-year-old woman with recurrent hypertensive crises was found to have a lipid-rich right adrenal adenoma. Biochemical evaluation was inconclusive for both pheochromocytoma and primary aldosteronism (PA). While 68Ga-DOTATATE PET/CT showed no abnormal uptake in the adrenal adenoma, effectively excluding pheochromocytoma, 68Ga-Pentixafor PET/CT demonstrated focal uptake within the adenoma, suggesting an aldosterone-producing adenoma. Given the high clinical suspicion for PA and the invasive nature of adrenal vein sampling, medical therapy with spironolactone was initiated and resulted in a favorable clinical response. This case highlights the potential diagnostic value of CXCR4-targeted PET/CT in suspected PA.