Adrenal Artery Ablation for the Treatment of Hypercortisolism Based on Adrenal Venous Sampling: A Potential Therapeutic Strategy

Abstract

Aim

Hypercortisolism is characterized by metabolic disorders and high mortality rates. Adrenalectomy and medical therapies are considered major treatment options. However, some patients, especially young patients, are strongly against undergoing surgery in case of secondary hypocortisolism or relapses that require replacement supplements or pharmacological interventions. In such cases, alternative therapies are needed to treat hypercortisolism.

Methods

We report a 27-year-old Chinese female with adrenal cortisol-producing adenoma. The patient’s circadian rhythm and concentrations of cortisol were abnormal, accompanying with an increased 24-hour urinary cortisol level. Computed tomography (CT) revealed a nodular soft-tissue mass in the right adrenal gland.

Results

Cortisol hypersecretion from the right adrenal gland was verified by adrenal venous sampling (AVS). Adrenal artery ablation was performed. After ablation, long-term follow-up showed that the patient’s symptoms subsided and abnormal laboratory test results returned to normal without pharmacological treatment.

Conclusion

AVS might be a promising method to aid the diagnosis of cortisol-producing adenoma. Adrenal artery ablation is minimally invasive and may be useful for the treatment of adrenal adenoma or nodular diseases, especially in patients who cannot undergo surgery.

Keywords:

• adrenal cortisol adenoma
• adrenal artery ablation
• adrenal venous sampling
• Cushing’s syndrome

Abbreviations

ACTH, adrenocorticotropic hormone; ACS, autonomous cortisol secretion; ARR, aldosterone-to-renin ratio; AVS, adrenal venous sampling; BMI, body mass index; CT, computed tomography; CS, Cushing’s syndrome; FBG, fasting blood glucose; IVC, inferior vena cava; LAV, left adrenal vein; LI, lateralization index; PA, primary aldosteronism; RAV, right adrenal vein; SI, selectivity index.

Consent for Publication

Written informed consent was obtained from the patient to publish their clinical details and images.

Author Contributions

All authors made substantial contributions to conception, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest for this work.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (NSFC No.81870641).