NP-59 Scan Test
Dose is specially ordered, when scheduling, notify technologist or physician.
Codes........................NCNP59
POE...........................NP 59 INJECTION + NP 59 SCAN
Anatomy Covered.... .Adrenal glands just superior to kidneys
Duration.....................30 minutes
Prior to Exam:
Prep..........................Lugol's solution for one-week prior to injection, as directed by Nuclear Medicine physician.
Diet/NPO requirements, contrast ingestion, etc.....None
Special Nursing Considerations............................None
Suggested Mode of Transportation......................Wheelchair or cart as patient requires.
Clothing Requirements, jewelry, etc......................Loose, comfortable clothing, no metal on abdomen.
Labs...................................................................None
Contraindications................................................None
During Exam:
Q: What will happen?
A: The patient will be asked to lie supine on scanning table. Two cameras, one above, and the other beneath the imaging table will scan the patient from head to foot, taking about 30 minutes.
Q: What will patient feel?
A: No adverse affect.
Q: What will patient need to do?
A: The patient will need to remain still during imaging.
After Exam:
Q: What should patient expect after exam?
A: No adverse affect.
Q: What should nurse look for after exam?
A: No adverse affect, resume normal activities.
Contraindications/Considerations/Risks and Benefits:
Patient pregnancy is the only contraindication when using radiopharmaceuticals. In such a case, the study must be cleared by the radiologist, and the dose injected is adjusted accordingly. No adverse affects, the information obtained by the study can support or determine a diagnosis, greatly benefiting the patient.
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Note: June's comments are in this type below.
ADRENAL SCINTIGRAPHY
1. Adrenocortical Imaging Agents
I-131 Iodocholesterol - NP-59, incorporated into LDL
LDL is the good cholesterol produced by the liver, low-density lipoprotein and is part of the liver's by-products--and is absorbed by the adrenal cortex rather than the adrenal medulla like a pheo
Absorbed from LDL by adrenal cortex
Detects ACTH independent Cushing Syndrome, adrenocort Ca
Hyperandrogenism & hyperfunctioning adenoma
It incorporates into the ACTH system: ACTH is the adrenocorticotrophic hormone involved. I am going to try to get a diagram of the hypothalamic-pituitary-target endocrine system, but for now, you just need to know the pituitary gland produces ACTH; ACTH in turn stimulates the adrenal cortex to produce cortisol; cortisol along with sympathetic nervous system activity "prepares" your body to defend itself, i.e. the 'fear' response
Dose - 1-2mCi, 26rad/mCi to adrenal, 8 to ovaries, 1.2 whole
Lugol solution given to suppress thyroid (suppresses thyroid activity by binding to available sites in the thyroid, so the radioactive iodine in the I131-isocholesteol does not attach there, and expose the tissue to radioactivity)
Image at 5-7d interval P injection
3-5d interval if used w dexamethasone sup
Dexamethasone is used when looking at primary aldersteronism, androgen or estrogen secreting adenomas
Se-75 Selenocholesterol (Scintadrin) - similar uptake properties
Have info on this isotope and ass't tests also
Dexamethasone Suppression Test - synthetic glucocorticoid
Suppresses N adrenal but not autonomously functioning adenoma
Causes both Cushing's & Conn's type adenomas to stand out
Using this shuts down a normal adrenal, but a separate, functioning adenoma stands out, as well as adenomas that are Cushing's and or Conn's (low cortisol, low androgen)
2. Sympathoadrenal Imaging Agents
I-131 metaiodobenzylguanidine (MIBG) - similar to norepi (one reason some are better risks at the mibg is that they secrete norepi -- I only throw epi, so it will never be able to attach to those sites needed for a good test in the time required before the isotope degrades in radioactive activity.)
Accumulates in neurosec granules of neurocrest origin cell
Chromaffin cells of adrenal medulla - 90% of pheochromocytoma
Melanocytes, C-cell of thyroid, panc cell, Kulchitsky
Neuroblastoma, carcinoid, paraganglioma, chorioca
These are all disorders with similar cellular background, ie chromaffin cells, developed in the fetal organism from neurocrest cells vs the regular nervous systems cellular structure, and cell base
Dose - .4mCi, 35rad/mCi to adrenal medulla, .22 whole
Lugol solution given for 7-10 days to block N thyroid uptake
Image at 24, 48 & 72hrs P injection
False negative - block w imipramine & tricyclic antidepressant
Notice that there are false negative mibg tests; they can be reduced by putting the patient on imiptamine or another tri-cyclic antidepressant; they block part of the chemical pathway od epi-, norepi, dopamine
I-123 MIBG - allows spect imaging, image at 6 & 24hrs
Bone uptake is always abnormal, indicates marrow involvement
In-111 Octreotide (octreoscan) - detects somatostatin receptor sites on tumors
neuroblastoma, pheo, carcinoid, pancreatic islet cell, medullary thyroid
breast cancer & lymphoma also - if positive may respond to somatostatin therapy
dosage can be boosted to Tx positive masses as well - dose??
Pheochromocytoma - can be evaluated w I-131 MIBG, a nor-epi analog
Localizes to sympathetic tissues, 90% sensitivity for pheo masses
N localization to liver, spleen, salivary, heart & bladder
Renal scans also w Tc-99m DTPA subtracted from MIBG images
Done only when equivicol CT & clinical findings, "The tumor of 10's"
10% in children, 10% extraadrenal, 10% malig, 10% w MEN II, 10% bilat
most <10cm, undiagnosed in 1/3, may be fatal, check VMA level in urine
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