Only a few days ago, did I realize that I had missed several questions from the Dr. Pheo blog. I have not received any email alerts on new questions since late May 2018. Initially I thought perhaps it was summer time or perhaps readers found answers from previous posts. Then I saw a few comments on the blog a few days ago. That was strange because I was supposed to get email alters on new comments. I certainly did not change any settings and I checked again and found all the settings were the same.
Then I googled the problem. Wow, so many other bloggers had similar problems. It looked like Google Blogger required bloggers to re-consent receiving email alerts. The bottom line is that I can now receive email alerts of your questions. If you posted questions in late May or after, and did not receive answers from me, please post your questions again if you still need the answers.
Dr. Pheo
Saturday, July 28, 2018
Thursday, June 28, 2018
Incidental pheo (?) found by DOTATATE PET
Whenever a new imaging method is used widely, incidental findings from it are encountered. The new Ga-68 DOTATATE PET is no exception. It is well known that DOTATATE signals are normally found in the pituitary, salivary glands, thyroid, liver, spleen, and adrenal glands. Some people may also have signals in the pancreas.
Although the adrenal glands are known to be lit up by DOTATATE PET, the signal from normal adrenal glands is usually low. A technical jargon called the standard uptake value (SUV) quantitatively describes the intensity of PET signals. Unfortunately, different machines give out different SUVs on the same organ of the same patient. The SUV thus has relative importance only in the same patient using the same machine.
I saw a patient recently. She had another kind of neuroendocrine tumor and did a DOTATATE PET. The PET showed she had strong signal on one adrenal gland (SUV ~8) while the other adrenal gland had normal signal (SUV ~2). CT showed a tiny nodule in the adrenal gland with strong PET signal. Is this a metastatic lesion of the other neuroendocrine tumor? Or is it a tiny pheo that is incidentally found by the DOATATE PET? Either adrenal metastasis from neuroendocrine tumor or pheo is rare. Based on a variety of factors, I favor she has a tiny pheo. There are no convincing ways to prove either diagnosis. Only time will tell.
Dr. Pheo
Although the adrenal glands are known to be lit up by DOTATATE PET, the signal from normal adrenal glands is usually low. A technical jargon called the standard uptake value (SUV) quantitatively describes the intensity of PET signals. Unfortunately, different machines give out different SUVs on the same organ of the same patient. The SUV thus has relative importance only in the same patient using the same machine.
I saw a patient recently. She had another kind of neuroendocrine tumor and did a DOTATATE PET. The PET showed she had strong signal on one adrenal gland (SUV ~8) while the other adrenal gland had normal signal (SUV ~2). CT showed a tiny nodule in the adrenal gland with strong PET signal. Is this a metastatic lesion of the other neuroendocrine tumor? Or is it a tiny pheo that is incidentally found by the DOATATE PET? Either adrenal metastasis from neuroendocrine tumor or pheo is rare. Based on a variety of factors, I favor she has a tiny pheo. There are no convincing ways to prove either diagnosis. Only time will tell.
Dr. Pheo
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