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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.


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Right inferior phrenic artery angiogram showing perfusion of the superior lateral limb of the adrenal gland (arrow) with the absence of adenoma blush.
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fig6: Right inferior phrenic artery angiogram showing perfusion of the superior lateral limb of the adrenal gland (arrow) with the absence of adenoma blush.

Mentions: The patient was placed under general anesthesia and intubated because of his labile blood pressures. After accessing the right common femoral artery, we cannulated the right lateral adrenal artery using the standard technique. Arteriogram showed significant adenoma blush (Fig. 2). Superselective coil embolization of an anomalous phrenic branch was then performed (Fig. 3). The catheter was next pulled back into the right lateral adrenal artery, and 3 mL of hydrated alcohol was injected. At this time, the patient experienced high blood pressures managed by the anesthesia team. Roughly 1 mL of 300-500 μm embospheres was then injected until stasis was achieved after which the proximal right lateral adrenal artery was coiled. Postembolization contrast injection demonstrated no tumor blush (Fig. 4). Right renal artery angiogram showed no evidence of adrenal capsular supply (Fig. 5). Right inferior phrenic artery angiography showed perfusion to the superior lateral limb of the adrenal gland without adenoma blush (Fig. 6).


Transarterial embolization of a hyperfunctioning aldosteronoma in a patient with bilateral adrenal nodules
Right inferior phrenic artery angiogram showing perfusion of the superior lateral limb of the adrenal gland (arrow) with the absence of adenoma blush.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

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

fig6: Right inferior phrenic artery angiogram showing perfusion of the superior lateral limb of the adrenal gland (arrow) with the absence of adenoma blush.
Mentions: The patient was placed under general anesthesia and intubated because of his labile blood pressures. After accessing the right common femoral artery, we cannulated the right lateral adrenal artery using the standard technique. Arteriogram showed significant adenoma blush (Fig. 2). Superselective coil embolization of an anomalous phrenic branch was then performed (Fig. 3). The catheter was next pulled back into the right lateral adrenal artery, and 3 mL of hydrated alcohol was injected. At this time, the patient experienced high blood pressures managed by the anesthesia team. Roughly 1 mL of 300-500 μm embospheres was then injected until stasis was achieved after which the proximal right lateral adrenal artery was coiled. Postembolization contrast injection demonstrated no tumor blush (Fig. 4). Right renal artery angiogram showed no evidence of adrenal capsular supply (Fig. 5). Right inferior phrenic artery angiography showed perfusion to the superior lateral limb of the adrenal gland without adenoma blush (Fig. 6).

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