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Transarterial embolization of a hyperfunctioning aldosteronoma in a patient with bilateral adrenal nodules

View Article: PubMed Central - PubMed

ABSTRACT

Primary hyperaldosteronism often results in resistant hypertension and hypokalemia, which may lead to cardiovascular and cerebrovascular complications. Although surgery is first line treatment for unilateral functioning aldosteronomas, minimally invasive therapies may be first line for certain patients such as those who cannot tolerate surgery. We present a case of transarterial embolization (TAE) of an aldosteronoma. The patient presented with a cerebrovascular accident, and subsequently developed uncontrolled hypertension, hypokalemia, and a myocardial infarction. Following TAE, potassium returned to normal levels and blood pressure control was improved. There were no postoperative complications. TAE thus may be a safe and effective alternative to surgery.

No MeSH data available.


Related in: MedlinePlus

Coronal CT slice demonstrating bilateral adrenal nodules with the right nodule (arrow) measuring 2.2 × 2.5 × 2.4 cm.
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fig1: Coronal CT slice demonstrating bilateral adrenal nodules with the right nodule (arrow) measuring 2.2 × 2.5 × 2.4 cm.

Mentions: The patient was a 70-year-old Hispanic male with a past medical history of an adrenal incidentaloma diagnosed 8 years ago, medically controlled hypertension, congestive heart failure, and atrial fibrillation who presented to an outside hospital for a cerebrovascular accident (CVA). Given the patient's history of adrenal nodule, the CVA was thought to be secondary to hypertension from a hyperfunctioning adrenal nodule. A contrast computer tomography (CT) scan was performed, which demonstrated a right nodule measured at 2.2 × 2.5 × 2.4 cm and a left nodule measured at 3.3 × 2.2 × 3.0 cm (Fig. 1). The right adrenal mass demonstrated approximately 88 Hounsfield units (HU) on the arterial phase, 52 HU in the portal venous phase, and 41 HU on the delayed phase, with a 21% relative washout. The left adrenal mass measured 80 HU, 59 HU, and 37 HU in the arterial, portal venous, and delayed phases, respectively, with a 37% relative washout. Both nodules were thus considered to be of indeterminate etiology based on CT criteria. The patient had refractory hypertension and while undergoing physical therapy for the CVA, his blood pressure suddenly rose to 280/110 mmHg. He was subsequently admitted to our hospital, where his blood pressure remained erratic and he developed hypokalemia with a nadir of 2.8 mEq/L.


Transarterial embolization of a hyperfunctioning aldosteronoma in a patient with bilateral adrenal nodules
Coronal CT slice demonstrating bilateral adrenal nodules with the right nodule (arrow) measuring 2.2 × 2.5 × 2.4 cm.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5310245&req=5

fig1: Coronal CT slice demonstrating bilateral adrenal nodules with the right nodule (arrow) measuring 2.2 × 2.5 × 2.4 cm.
Mentions: The patient was a 70-year-old Hispanic male with a past medical history of an adrenal incidentaloma diagnosed 8 years ago, medically controlled hypertension, congestive heart failure, and atrial fibrillation who presented to an outside hospital for a cerebrovascular accident (CVA). Given the patient's history of adrenal nodule, the CVA was thought to be secondary to hypertension from a hyperfunctioning adrenal nodule. A contrast computer tomography (CT) scan was performed, which demonstrated a right nodule measured at 2.2 × 2.5 × 2.4 cm and a left nodule measured at 3.3 × 2.2 × 3.0 cm (Fig. 1). The right adrenal mass demonstrated approximately 88 Hounsfield units (HU) on the arterial phase, 52 HU in the portal venous phase, and 41 HU on the delayed phase, with a 21% relative washout. The left adrenal mass measured 80 HU, 59 HU, and 37 HU in the arterial, portal venous, and delayed phases, respectively, with a 37% relative washout. Both nodules were thus considered to be of indeterminate etiology based on CT criteria. The patient had refractory hypertension and while undergoing physical therapy for the CVA, his blood pressure suddenly rose to 280/110 mmHg. He was subsequently admitted to our hospital, where his blood pressure remained erratic and he developed hypokalemia with a nadir of 2.8 mEq/L.

View Article: PubMed Central - PubMed

ABSTRACT

Primary hyperaldosteronism often results in resistant hypertension and hypokalemia, which may lead to cardiovascular and cerebrovascular complications. Although surgery is first line treatment for unilateral functioning aldosteronomas, minimally invasive therapies may be first line for certain patients such as those who cannot tolerate surgery. We present a case of transarterial embolization (TAE) of an aldosteronoma. The patient presented with a cerebrovascular accident, and subsequently developed uncontrolled hypertension, hypokalemia, and a myocardial infarction. Following TAE, potassium returned to normal levels and blood pressure control was improved. There were no postoperative complications. TAE thus may be a safe and effective alternative to surgery.

No MeSH data available.


Related in: MedlinePlus