Accuracy of 68Ga-Pentixafor PET/CT for Subtypting Diagnosis in Patients With Primary Aldosteronism Concurrent With Autonomous Cortisol Secretion

Inclusion Criteria:

1. Getting the written informed consent

2. The clear diagnosis of primary aldosteronism；

3. Combined with autonomous cortisol secretion, cortisol after 1mg dexamethasonesuppression test (DST) ≥50 nmol/l；

4. Patients who are willing to undergo surgery；

5. Adrenal CT or MRI scan of the adrenal glands with nodule (≥1cm).

Exclusion Criteria:

1. PA patients who meet the by-passing AVS criteria [i.e., younger than 35 years old,spontaneous hypokalemia, adrenal CT indicated unilateral low-density adenoma (≥1cm),plasma aldosterone >300pg/ml]；

2. Suspicion of familial hyperaldosteronism or Liddle syndrome. [i.e., age <20years, hypertension and hypokalemia, or with family history]；

3. Suspicion of pheochromocytoma or adrenal carcinoma；

4. Patients with actively malignant tumor；

5. Patients who have adrenalectomy history；

6. Long-term use of glucocorticoids；

7. Patients who are allergic to contrast media and cannot tolerate AVS；

8. Pregnant or lactating women; with alcohol or drug abuse and mental disorders；

9. Congestive heart failure with New York Heart Association (NYHA) FunctionalClassification III or IV; History of serious cardiovascular or cerebrovasculardisease (angina, myocardial infarction or stroke) in the past 3 months; Severeanemia (Hb<60g/L); Serious liver dysfunction or chronic kidney disease aspartateaminotransferase (AST) or alanine transaminase (ALT) ≥3 times the upper limit ofnormal, or estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2);Systemic Inflammatory Response Syndrome (SIRS); Uncontrolled diabetes (FBG≥13.3mmol/L); Obesity (BMI≥35 kg/m²); Untreated aneurysm; Other comorbidity potentiallyinterfering with treatment；

10. Consider patients with bilateral cortisol hypersecretion such as PBMAH or PPNAD.