Fortuitous Hormonal Ablation of Adrenal Aldosteronoma due toa Complication, Adrenal Venous Infarction by Adrenal Venographyduring Adrenal Vein Sampling: Case Report

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概要

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• A 61-year-old woman was admitted to our Department for examination of uncontrollable hypertension. An aldosteroneproducingadenoma (aldosteronomas) was suspected based on her hypertension, low plasma renin activity and a rightadrenal mass on CT, although plasma and urinary aldosterone levels were within normal ranges. Because of the ambiguoushormonal results, we performed adrenal vein sampling including bilateral adrenal veins and the inferior vena cava. Theresults of aldosterone and cortisol levels of the blood samples reported later confirmed an aldosteronomas in the rightadrenal gland. Immediately after the second right adrenal venography after successful sampling followed by the firstuneventful right venography, the patient complained of back pain and CT revealed the swollen right adrenal gland with highdensity, suggesting a complication of intra-adrenal hemorrhagic venous infarction. Thereafter, her hypertension improved,plasma aldosterone levels decreased to a lower normal limit, and plasma renin activity returned to a normal range. CTobtained 3 months later and adrenocortical scintigraphy performed 6 months later revealed that most of the aldosteronomawas necrotic. During the 9-months follow-up period, hormonal ablation of the aldosteronoma was maintained. Althoughhormonal ablation of the aldosteronoma was fortuitously obtained in our case, adrenal venography should be performedwith meticulous care and after confirmation of smooth blood flow into the syringe connected with the catheter by pullingthe plunger.　Manual injection of the contrast medium into the adrenal vein should be made as gentle and slow as possibleto avoid complications, especially in case of prolonged wedge of the catheter tip in the adrenal vein.

• 鹿児島大学,Kagoshima Universityの論文

著者

• 馬場 康貴

  鹿児島大学 大学院医歯学総合研究科腫瘍制御学･消化器外科学

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