Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Case Report

Volume 10, Number 1, January 2018, pages 66-71

Persistent Primary Aldosteronism Despite Iatrogenic Adrenal Hemorrhage After Adrenal Vein Sampling

Figures

Figure 1.
Figure 1. Plain CT prior to AVS. CT detected an adrenal mass 1.4 cm in diameter (arrows).
Figure 2.
Figure 2. Fluoroscopy images immediately after AVS. Left: LAO90, CRA0; right: RAO90, CRA0. The patient complained of chest discomfort and back pain after AVS, and pooling of contrast medium was noted at that time in the entire right adrenal gland (dotted circle).
Figure 3.
Figure 3. Plain CT after AVS. Immediately after AVS, pooling of contrast medium in the entire right adrenal gland was observed (arrow).
Figure 4.
Figure 4. Results of AVS. Blood sampling site numbers are in parentheses. Plasma aldosterone concentration (pg/mL)/plasma renin activity (ng/mL/h) = aldosterone-renin ratio.
Figure 5.
Figure 5. Plain CT at 60 days after AVS. The hematoma is smaller, but the adrenal gland is slightly enlarged (arrows).
Figure 6.
Figure 6. Cut surfaces of the resected right adrenal gland. The adrenal gland shows focal necrosis and hemorrhage cystic change, probably due to AVS.

Table

Table 1. Changes of BP, PR and Endocrine Markers
 
Before AVS (nifedipine 40 mg)2 weeks after AVS (nifedipine 40 mg)After adrenalectomy (no medication)
PR: pulse rate; PRA: plasma renin activity; PAC: plasma aldosterone concentration; ARR: aldosterone-renin ratio.
SBP, mm Hg136137121
DBP, mm Hg809583
PR, bpm789267
PRA, ng/mL/h0.20.10.4
Cortisol, µg/dL9.99.17.2
PAC, pg/mL355105124
ARR1,7751,050310