18F-FDG PET as a Monitoring Tool to Assess Treatment Response in Bilateral Adrenal Histoplasmosis

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A 60-year-old woman with clinical and biochemical features suggestive of adrenal insufficiency was found to have bilateral adrenal masses on CT scan and was subjected to 18F-FDG PET scan. The scan showed hypermetabolic mediastinal nodes in addition to intense tracer uptake in bilateral adrenal masses. CT-guided adrenal biopsy grew Histoplasma capsulatum on Sabouraud dextrose agar culture. A second 18F-FDG PET scan after 6 months of appropriate antifungal therapy showed a significant decrease in intensity of uptake consistent with the clinical outcome.

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