RADIONUCLIDE ADRENAL IMAGING IN HYPERTENSION

这项拟议工作的目标有三个：1.证实 更大规模的前瞻性研究我们目前已在45年完成可行性研究 病人。这项研究表明，地塞米松抑制肾上腺 放射性碘化胆固醇闪烁扫描显示4种解剖功能 低肾素高血压患者的影像表现：1.摄取 I-131仅见于一侧肾上腺皮质的腺瘤。2. 大结节增生症的早期和晚期对称性摄取 肾上腺皮质。3.示踪剂后4天或更长时间对称性摄取 给药可见于小结节增生症。4.两种语言都不能理解 当肾上腺皮质正常时，肾上腺出现早或晚。血样 在服用螺内酯期间，压力下降到正常水平 核素扫描发现肾上腺皮质异常，但无反应 当肾上腺皮质正常时对螺内酯有显著影响。2.至 放射性标记肾上腺酶抑制剂的合成、开发和评价 腺体将减少成像所需的时间和辐射剂量 与目前使用的放射性碘化胆固醇进行比较。3.要合成， 开发和评估的解剖功能成像能力 放射性标记神经元阻滞剂和可逆酶抑制剂 肾上腺髓质。最成功的诊断能力 这些放射性标记显像剂将首先在患者身上进行分析 肾上腺髓质疾病的风险，然后是正常和高水平的患者 肾素高血压。

The objectives of this proposed work are three-fold: 1. To corroborate in a larger prospective study our presently completed feasibility study in 45 patients. This study illustrates that dexamethasone suppression adrenal scintiscanning with radioiodinated cholesterol reveals 4 anatomical-functional imaging patterns in patients with low renin essential hypertension: 1. Uptake of I-131 in one adrenal only is found in an adenoma of one adrenal cortex. 2. Symmetrical uptake early and late is found in macronodular hyperplasia of the adrenal cortex. 3. Symmetrical uptake four days or more after tracer administration is found in micronodular hyperplasia. 4. No uptake in either adrenal early or late is found when the adrenal cortices are normal. Blood pressure falls to normal during the administration of spironolactone when the adrenal cortex is abnormal as recognized by scintiscanning but does not respond significantly to spironolactone when the adrenal cortex is normal. 2. To synthesize, develop and evaluate radiolabeled inhibitors of enzymes in adrenal glands would decrease the time required for imaging and the radiation dose in comparison to the currently used radioiodinated cholesterols. 3. To synthesize, develop and evaluate the anatomical-functional imaging capabilities of radiolabeled neuronal blocking agents, and reversible inhibitors of enzymes in the adrenal medulla. The diagnostic capabilities of the most successful of these radiolabeled imaging agents will be analyzed first in patients most at risk for disease of the adrenal medulla, then in patients with normal and high renin hypertension.