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11C-metomidate is a radiopharmaceutical PET (Positron Emission Tomography) imaging agent specifically designed for the visualization and characterization of adrenocortical tissue. It is a carbon-11 labeled analogue of metomidate, the methyl ester of the anesthetic etomidate. The drug acts as a high-affinity ligand for the cytochrome P450 enzymes **11β-hydroxylase (CYP11B1)** and **aldosterone synthase (CYP11B2)**, which are primarily expressed in the adrenal cortex. By binding to these enzymes, 11C-metomidate allows for the non-invasive detection of adrenocortical tumors, such as adenomas and carcinomas, and is particularly useful in the clinical workup of primary aldosteronism (Conn's syndrome) to lateralize aldosterone-producing lesions. It serves as a functional imaging tool to distinguish adrenocortical lesions from non-cortical adrenal masses.
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