An Unusual Case of Primary Aldosteronism with Negative 68Ga-Pentixafor PET/CT and Positive FDG-PET/CT in a Left Adrenal Adenoma

A 65-year-old male with systemic hypertension, progressively rising aldosterone levels, low plasma renin activity, contrast Magnetic resonance imaging (MRI) described left adrenal lesion isointense to liver parenchyma on T2-weighted images and other features suggestive of left adrenal incidentaloma underwent ⁶⁸Ga-Pentixafor Positron emission tomography-computed tomography (PET/CT), which unexpectedly did not show tracer uptake in the known left adrenal adenoma. However, the said nodule showed significant focal tracer uptake on F-18 Fluorodeoxyglucose (FDG)-PET/CT that was done within 2 weeks of ⁶⁸Ga-Pentixafor PET/CT study. This unusual finding, which has hitherto been unreported in known patients of primary aldosteronism needs further exploration to determine its clinical significance.