A Case of Hypertensive Crisis without a Surge in Adrenal Hormones after Radiofrequency Ablation as a Treatment for Primary Hepatocellular Carcinoma

Abstract

Radiofrequency ablation (RFA) is a minimally invasive procedure that has been considered as a relatively safe treatment for patients with small hepatocellular carcinoma (HCC). However, RFA has been shown to be associated with complications including mechanical and thermal damage. A 74-year-old man with hepatitis C virus-associated HCC was admitted to our hospital. Abdominal computed tomography revealed two lobulated-HCC in segments 4 and 5. He had no medical history of hypertension and cardiac disease. During RFA, blood pressure was elevated to 200/140 mmHg. There was no evidence of pulmonary embolism, aortic dissection, or ischemic heart disease. Laboratory findings for catecholamine surge were all within normal limits. After continuous intravenous nitroglycerin and oral beta-blocker treatment, patient's blood pressure gradually decreased and back within the normal range. Hypertensive crisis after RFA treatment for HCC is rare. Most reported cases of hypertensive crisis during RFA were related to adrenal gland injury with a release of catecholamine. In our case, the site of HCC was not close to the adrenal gland, and there was no evidence of catecholamine surge. Herein, we report a very rare case of hypertensive crisis without a surge in adrenal hormones after RFA treatment for HCC. (Korean J Gastroenterol 2017;70:198-201)

Percutaneous Adrenal Radiofrequency Ablation: A Short Review for Endocrinologists

“…Hypertensive crisis is frequently encountered during RFA procedures due to excessive excretion of catecholamines from the ablated adrenal medulla [41][42][43][44][45]. Theoretically, this complication is more severe in patients with pheochromocytomas producing epinephrine and norepinephrine [46][47][48][49].…”

“…An arterial line should be secured to keep monitoring BP because of the possibility of rapid hemodynamic changes [41][42][43][44][45]. Anesthesiologists should have alpha blockers prepared in a syringe to intravenously inject as soon as rapid increases in BP are detected.…”

“…Hypertensive crisis is the most common complication during the procedure and rapid increases in BP may complicate cerebrovascular and cardiovascular diseases ( Fig. 1) [41][42][43][44][45]. Appropriate medication is necessary to prevent hypertensive crisis prior to or during RFA procedures [50][51][52][53].…”