Percutaneous computed tomography-guided ethanol injection in aldosterone-producing adrenocortical adenoma

Abstract

The feasibility, safety and effectiveness of percutaneous computed tomography-guided ethanol injection (PEI-CT) was investigated in a patient affected by aldosterone-producing adenoma (APA). A 42-year-old male patient with typical features of hyperaldosteronism presented a solitary left adrenal adenoma measuring 2 cm, with a normal contralateral gland, evidenced by both CT scan and adrenal [75Se-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 twofold increase in aldosterone and cortisol plasma levels were observed, respectively. After 11 days on a normal sodium and potassium diet, normal potassium plasma levels and reduced aldosterone plasma levels were present, 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 and maintenance of normal potassium plasma levels even on a high sodium and normal potassium diet. The patient has remained hypertensive, although 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 approach to surgery in the management of carefully selected patients with APA.

CT-Guided Acetic Acid Injection Therapy for Aldosterone-Producing Adrenocortical Adenoma. A Preliminary Report of Three Cases.

“…Recently PEI has also been employed for the treatment of endocrine tumors of the thyroid and parathyroid [3][4][5] . In addition, the use of a high concentration of acetic acid, instead of ethanol, has achieved safer and more effective results [6][7] With respect to percutaneous injection therapy for adrenocortical solid tumors, however, only 1 case with aldosterone-producing adenoma (APA) has ever been reported to be successfully treated by PEI in spite of associated massive leakage [8]. Here we present 3 cases with APA who have undergone computed tomography(CT)-guided percutaneous acetic acid injection (PAT) therapy.…”

Recurrence of primary aldosteronism after percutaneous ethanol injection

“…5 PEI has been widely used in small hepatocellular carcinoma (HCC), and the survival rates of surgical resection and PEI are comparable. 6 The application of PEI in nodular lesion of endocrine glands, including thyroid, parathyroid, and adrenal glands, has also been proposed. 6 A retrospective study evaluated the effectiveness of CT-guided percutaneous chemical ablation of adrenal neoplasms under CT guidance.…”

“…6 The application of PEI in nodular lesion of endocrine glands, including thyroid, parathyroid, and adrenal glands, has also been proposed. 6 A retrospective study evaluated the effectiveness of CT-guided percutaneous chemical ablation of adrenal neoplasms under CT guidance. 7 Of the seven patients with PA, all reached the normal range of serum potassium level, PAC, Figure 1 The computed tomography scan revealed a hypodense tumor at the right adrenal gland (arrow) 4 years after the first percutaneous ethanol injection.…”

“…Ethanol and acetic acid are the most commonly agents used for chemical ablation. 6,7 The mechanism of action is cytoplasmic dehydration followed by coagulation necrosis, fibrous reaction, and microvascular thrombosis. The difference is that the ethanol has difficulty in penetrating tumor septa well and is used in small tumors (<3 cm).…”

Midterm Outcome of Ultrasound-Guided Alcohol Gel Sclerotherapy for Symptomatic Leiomyoma

“…7 Ultrasound-guided ethanol injection has been used in the treatment of a variety of solid and cystic masses, such as renal, splenic, hepatic, and thyroid cysts. [7][8][9][10][11][12] Important advantages of this technique are its low cost and few adverse effects. Ultrasound-guided ethanol injection was first used to treat gynecologic conditions in 1988; since then, many investigators have reported favorable results for ablation of ovarian tumors.…”