Zhou Yaqiong, Wang Dan, Liu Qiting, Hou Jixin, Wang Peijian
Department of Cardiology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
Key Laboratory of Aging and Vascular Homeostasis of Sichuan Higher Education Institutes, Chengdu, China.
Front Cardiovasc Med. 2022 Oct 11;9:1013426. doi: 10.3389/fcvm.2022.1013426. eCollection 2022.
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.
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.
Superselective adrenal arterial embolization could be an alternative treatment for patients with aldosterone-producing adenoma who refuse adrenalectomy.
原发性醛固酮增多症是难治性高血压的常见病因。因醛固酮分泌性腺瘤导致原发性醛固酮增多症的患者通常采用单侧肾上腺切除术或药物治疗。超选择性肾上腺动脉栓塞术是单侧原发性醛固酮增多症患者的一种替代治疗方法。
我们报告一名39岁男性患者，有5年原发性醛固酮增多症和继发性高血压病史。患者拒绝肾上腺切除术，接受药物治疗。尽管服用了足够剂量的螺内酯，但患者因低钾血症反复出现肌肉无力，血压控制不佳，伴有左心室肥厚和肾功能不全。通过计算机断层扫描和肾上腺静脉采血确诊左侧肾上腺有醛固酮分泌性腺瘤。经确认，为醛固酮分泌性腺瘤提供主要动脉血供的左中肾上腺动脉，通过注入2毫升乙醇进行了栓塞。栓塞使他的血压正常化长达3个月，并逆转了左心室肥厚。
超选择性肾上腺动脉栓塞术可能是拒绝肾上腺切除术的醛固酮分泌性腺瘤患者的一种替代治疗方法。
