Case report: Percutaneous adrenal arterial embolization cures resistant hypertension

Yaqiong Zhou, Dan Wang, Qiting Liu, Jixin Hou, Peijian Wang, Yaqiong Zhou, Dan Wang, Qiting Liu, Jixin Hou, Peijian Wang

Abstract

Background: Primary aldosteronism is a common cause of resistant hypertension. Patients with primary aldosteronism due to aldosterone-producing adenoma are generally treated with unilateral adrenalectomy or medical therapy. Superselective adrenal arterial embolization is an alternative treatment for patients with unilateral primary aldosteronism.

Case summary: We present a 39-year-old male patient with a 5-year history of primary aldosteronism and secondary hypertension. The patient refused adrenalectomy while accepted pharmacotherapy. Despite taking adequate dose of spironolactone, the patient experienced repeatedly muscle weakness due to hypokalemia and had poor blood pressure control with left ventricular hypertrophy and renal dysfunction. Aldosterone-producing adenoma in the left adrenal gland was confirmed by computerized tomography and adrenal venous sampling. The left middle adrenal artery, which was confirmed to provide the main arterial supply to the aldosterone-producing adenoma, was embolized by injecting 2 ml ethanol. The embolization normalized his blood pressure for up to 3 months and reversed left ventricular hypertrophy.

Conclusion: Superselective adrenal arterial embolization could be an alternative treatment for patients with aldosterone-producing adenoma who refuse adrenalectomy.

Keywords: ablation; adrenal arterial embolization; case report; hypertension; primary aldosteronism.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Zhou, Wang, Liu, Hou and Wang.

Figures

FIGURE 1
FIGURE 1
Contrast-enhanced computerized tomography scan showing a small left adrenal adenoma. (A) Coronal view. (B) Cross-sectional view.
FIGURE 2
FIGURE 2
Superselective adrenal arterial embolization. (A) Angiography of the left middle adrenal artery showing enhancement of the left adrenal adenoma (Arrow). (B) Post-embolization angiography of the left middle adrenal artery confirming no blood flow to the adenoma (Arrow).
FIGURE 3
FIGURE 3
The effects of superselective adrenal arterial embolization (SAAE). Office (A) and mean ambulatory blood pressure (BP) (B), plasma aldosterone levels (C), and aldosterone to renin ratios (ARR) (D) of the patient before SAAE and 3 days, 1 month, and 3 months after SAAE. Contrast-enhanced computerized tomography showing disappearance of the left adrenal adenoma. (E) Coronal view. (F) Cross-sectional view. Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure.

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