Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy

Qing Zhou, Xiaoli Liu, Hexuan Zhang, Zhigang Zhao, Qiang Li, Hongbo He, Zhiming Zhu, Zhencheng Yan, Qing Zhou, Xiaoli Liu, Hexuan Zhang, Zhigang Zhao, Qiang Li, Hongbo He, Zhiming Zhu, Zhencheng Yan

Abstract

Aim: Hypercortisolism is characterized by metabolic disorders and high mortality rates. Adrenalectomy and medical therapies are considered major treatment options. However, some patients, especially young patients, are strongly against undergoing surgery in case of secondary hypocortisolism or relapses that require replacement supplements or pharmacological interventions. In such cases, alternative therapies are needed to treat hypercortisolism.

Methods: We report a 27-year-old Chinese female with adrenal cortisol-producing adenoma. The patient's circadian rhythm and concentrations of cortisol were abnormal, accompanying with an increased 24-hour urinary cortisol level. Computed tomography (CT) revealed a nodular soft-tissue mass in the right adrenal gland.

Results: Cortisol hypersecretion from the right adrenal gland was verified by adrenal venous sampling (AVS). Adrenal artery ablation was performed. After ablation, long-term follow-up showed that the patient's symptoms subsided and abnormal laboratory test results returned to normal without pharmacological treatment.

Conclusion: AVS might be a promising method to aid the diagnosis of cortisol-producing adenoma. Adrenal artery ablation is minimally invasive and may be useful for the treatment of adrenal adenoma or nodular diseases, especially in patients who cannot undergo surgery.

Keywords: Cushing’s syndrome; adrenal artery ablation; adrenal cortisol adenoma; adrenal venous sampling.

Conflict of interest statement

The authors declare that they have no conflicts of interest for this work.

© 2020 Zhou et al.

Figures

Figure 1
Figure 1
Adrenal contrast-enhanced computed tomography at the patient’s first hospital visit. Arrow indicates adrenal adenoma.
Figure 2
Figure 2
Adrenal non-contrast computed tomography after adrenal artery ablation. Arrow indicates adrenal adenoma.

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