Over the past 5 years, two tracers (11C-methionine and 11C-metomidate) have transformed the care of subgroups of patients with pituitary and adrenal tumours who were previously deemed unsuitable for surgery, and who had often been consigned to a lifetime of expensive/poorly tolerated medical treatment, are, in many instances, undergoing curative surgery.
For example, a single 11C-methionine scan costing £1250 may facilitate curative trans sphenoidal surgery (£6,500), allowing the discontinuation of drugs (e.g. somatostatin analogues such as lanreotide Autogel or Sandostatin LAR) costing >£10,000 per annum, thus not only improving quality of life, but also producing considerable costs savings for the NHS (Koulouri et al Eur J Endocrinol 2016, 175(5):485-498. PMID: 2756240; Koulouri et al Eur J Endocrinol, 2015, 173(4):M107-20 PMID: 26245763). Similarly, in primary aldosteronism (which is now recognised to be the commonest secondary cause of hypertension (5-10% of all cases and 20- 25% of refractory hypertension), 11C-metomidate PET-CT has facilitated curative surgery (unilateral adrenalectomy) in patients who have previously had failed adrenal vein sampling and were therefore unable to proceed further along the surgical pathway (Burton et al 2012. J Clin Endocrinol Metab, 97(1):100- 9. PMID: 22112805). Currently, Dr Gurnell is processing 3-5 new referrals every week from around the UK and overseas – including Europe, USA and even Australia without even advertising the service. The pituitary PET studies were initially funded from JDP’s NIHR senior investigator award and substantial funding has now followed (NIHR EME, MRC DPFS and Evelyn Trust awards). Novel tracers for these patient groups are being explored together with health economic issues around such a ‘disruptive technology’ with the aid of methods such as decision analytic models (Drummond MF, Methods for the Economic Evaluation of Health Care Programmes, Oxford University Press, 2005; Heinzel et al J Nucl Med. 2013).