PERCUTANEOUS COMPUTED TOMOGRAPHY-GUIDED ETHANOL INJECTION IN ALDOSTERONE-PRODUCING ADRENOCORTICAL ADENOMA

The feasibility, safety and effectiveness of percutaneous computed tom ography-guided ethanol injection (PEI-CT) was investigated in a patien t affected by aldosterone-producing adenoma (APA). A 42-year-old male patient with typical features of hyperaldosteronism presented a solita ry left adrenal adenoma measuring 2 cm, with a normal contralateral gl and, evidenced by both CT scan and adrenal [Se-75-19]-nor-cholesterol scintigraphy. After normalization of potassium plasma levels, 4 ml of sterile 95% ethanol with 0.5 ml of 80% iothalamate sodium was injected . The procedure was completed in about 30 min. No severe pain or local complication was noted. Five hours after PEI, a fourfold and a twofol d increase in aldosterone and cortisol plasma levels were observed, re spectively. After 11 days on a normal sodium and potassium diet, norma l potassium plasma levels and reduced aldosterone plasms levels were p resent, with reappearance of an aldosterone postural response. Plasma renin activity and aldosterone plasma levels normalized 1 month later, with reappearance also of a plasma renin activity postural response a nd maintenance of normal potassium plasma levels even on a high sodium and normal potassium diet. The patient has remained hypertensive, alt hough lower antihypertensive drug dosages have been employed. After 17 months, normal biochemical, hormonal and morphological findings were still present. Thus, we suggest PEI-CT as a further alternative approa ch to surgery in the management of carefully selected patients with AP A.