PMC9592891_01
Contrast-enhanced computerized tomography scan showing a small left adrenal adenoma. (A) Coronal view. (B) Cross-sectional view.
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The contrast-enhanced computerized tomography scan of the abdomen revealed a small left adrenal adenoma of 1.0 x 0.8 cm (Figures 1A,B).
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).
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The arterial supply to the aldosterone-producing adenoma was confirmed as the left middle adrenal artery arising from the abdominal aorta by angiography (Figure 2A). Angiography at 5 min post-embolization confirmed no blood flow to the aldosterone-producing adenoma (Figure 2B).
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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His office blood pressure decreased to 136/78 mmHg on day 3 post-embolization and was kept below 140/80 mmHg for up to 3 months after the procedure (Figure 3A). Ambulatory blood pressure monitoring confirmed that hypertension of the patient was cured by the left superselective adrenal arterial embolization (Figure 3B). Plasma aldosterone and aldosterone-to-renin ratio were corrected on day 3 post-embolization and maintained at low levels for 3 months (Figures 3C,D). Abdominal computerized tomography scan at 3 months post-procedure demonstrated disappearance of left adrenal adenoma (Figures 3E,F).