Persistent Primary Aldosteronism Despite Iatrogenic Adrenal Hemorrhage After Adrenal Vein Sampling

Okamura, Keisuke; Okuda, Tetsu; Shirai, Kohji; Abe, Ichiro; Kobayashi, Kazuo; Ishii, Tatsu; Haraoka, Seiji; Urata, Hidenori

doi:10.14740/jocmr3243w

Cited by 5 publications

(9 citation statements)

References 21 publications

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“…Surgical adrenalectomy (or partial resection) can decrease the cardiovascular risk associated with excessive aldosterone production. However, physicians tend to hesitate to perform AVS and adrenalectomy [4,10,11]. Accordingly, many primary aldosteronism patients receive oral MR antagonist therapy as an alternative to surgery, including some patients who could be cured by surgery.…”

Section: Discussionmentioning

confidence: 99%

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A Patient with Bilateral Primary Aldosteronism Refractory to Oral Eplerenone Who Responded to Esaxerenone with Increased Renin Activity

et al. 2020

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Adverse events of drug therapy Background: When mineralocorticoid receptor antagonist therapy is initiated for primary aldosteronism, the response of plasma renin activity indicates the level of cardiovascular risk. The purpose of this article was to compare the effect of mineralocorticoid receptor blockers on plasma renin activity levels in a patient with primary aldosteronism. Case Report: The patient was a 45-year-old male with severe hypertension. Because his aldosterone/renin ratio was high and a saline infusion test was positive, primary aldosteronism was diagnosed. Computed tomography revealed a low-density mass measuring 10 mm in the left adrenal gland. Segmental adrenal vein sampling demonstrated bilateral primary aldosteronism, so pharmacotherapy was started. Before treatment, his plasma renin activity was 0.5 ng/mL/hour. Eplerenone was commenced and the dose was increased to 100 mg/day. However, his plasma renin activity was still 0.8 ng/mL/hour and the maximum dose of eplerenone did not elevate plasma renin activity above 1 ng/mL/hour. Since plasma renin activity remained below 1 ng/mL/hour with mineralocorticoid receptor antagonist therapy, this patient was considered to have a higher cardiovascular risk than patients with essential hypertension. Accordingly, eplerenone was switched to esaxerenone, a new generation mineralocorticoid receptor blocker that became available in May 2019. After switching to esaxerenone (5 mg/day), the patient's plasma renin activity increased to 1.8 ng/mL/hour and subsequently remained at 1 ng/mL/hour or higher. Conclusions: This is the first case report to present interesting changes of plasma renin activity in a primary aldosteronism patient after switching from eplerenone to esaxerenone. Elevation of plasma renin activity by esaxerenone in our primary aldosteronism patient reflected a mineralocorticoid receptor antagonistic effect that may have alleviated excessive mineralocorticoid receptor activation and volume expansion.

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Section: Discussionmentioning

confidence: 99%

“…Before S-AVS, infusion of synthetic adrenocorticotropic hormone (tetracosactide acetate) was commenced at 0.1 mg/hour. We performed S-AVS under guidance with biplane cine angiography [4]. Then a microcatheter was advanced through the guiding catheter into the segmental adrenal tributary vein.…”

Section: Case Reportmentioning

confidence: 99%

A Patient with Bilateral Primary Aldosteronism Refractory to Oral Eplerenone Who Responded to Esaxerenone with Increased Renin Activity

et al. 2020

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“…S-AVS was performed using a system that is easily available to cardiologists [1]. The S-AVS procedure combined a 6.5 French guiding catheter with a Y-shaped connector [3], and biplane cine angiography [4]. Engagement in the adrenal vein was achieved and imaging was performed following injection of contrast medium through the guiding catheter.…”

Section: Case Reportmentioning

confidence: 99%

“…Engagement in the adrenal vein was achieved and imaging was performed following injection of contrast medium through the guiding catheter. During S-AVS, an OM type 2.2 Fr Gold Crest split-tip microcatheter (Koshin Medical, Co. Ltd.; Tokyo, Japan) was advanced into the segmental adrenal vein through the 6.5 French guiding catheter, which allowed sampling to be performed at 15 sites [4].…”

Section: Case Reportmentioning

confidence: 99%

“…However, we have previously reported a modified method for AVS that allows it to be performed relatively easily [3,4]. When performing percutaneous coronary intervention (PCI), the cardiologist usually advances the wire and microcatheter while using a guiding catheter with a Y-shaped connector and confirming the progress of the procedure using fluoroscopy or biplane cine angiography.…”

Section: Introductionmentioning

confidence: 99%

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A Case of Primary Aldosteronism Due to A Primary Adrenal Adenoma Diagnosed by Segmental Adrenal Venous Sampling (S-AVS) Using a Modified Catheter System and Lateral Cine Angiography

et al. 2019

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Patient: Male, 44Final Diagnosis: Aldosterone producing adenomaSymptoms: HypertensionMedication: —Clinical Procedure: Segmental adrenal venous samplingSpecialty: CardiologyObjective:Unusual clinical courseBackground:Before partial adrenalectomy for primary aldosteronism due to a primary adrenal adenoma, the aldosterone-producing tumor can be localized by segmental adrenal vein sampling (S-AVS). Cardiologists, who regularly perform percutaneous coronary intervention (PCI), or coronary angioplasty with stent, may not be familiar with the technique of S-AVS. A case of the use of S-AVS is reported in a patient who presented with primary aldosteronism and a right adrenal adenoma.Case Report:A 44-year-old man with a history of hypertension presented with a man in the posterior part of the right adrenal gland. He had hypokalemia, and a high plasma aldosterone concentration/plasma renin activity ratio. A captopril stress test confirmed the diagnosis of primary aldosteronism. Pre-operative S-AVS was performed using a microwire and microcatheter, which were advanced into the segmental adrenal vein using a 6.5 French guiding catheter and a Y-shaped connector, under biplane cine angiography guidance. S-AVS showed a high plasma aldosterone concentration in the right superior tributary adrenal vein draining the adrenal mass. Right partial adrenalectomy was performed. Postoperatively, the patient’s blood pressure and plasma aldosterone levels normalized.Conclusions:S-AVS can be performed relatively easily before partial adrenalectomy using a catheter system with biplane cine angiography, which is a technique that is familiar to cardiologists.

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Imaging CXCR4 expression in patients with suspected primary hyperaldosteronism

Ding

Zhang

Wen

et al. 2020

Eur J Nucl Med Mol Imaging

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Persistent Primary Aldosteronism Despite Iatrogenic Adrenal Hemorrhage After Adrenal Vein Sampling

Cited by 5 publications

References 21 publications

A Patient with Bilateral Primary Aldosteronism Refractory to Oral Eplerenone Who Responded to Esaxerenone with Increased Renin Activity

A Patient with Bilateral Primary Aldosteronism Refractory to Oral Eplerenone Who Responded to Esaxerenone with Increased Renin Activity

A Case of Primary Aldosteronism Due to A Primary Adrenal Adenoma Diagnosed by Segmental Adrenal Venous Sampling (S-AVS) Using a Modified Catheter System and Lateral Cine Angiography

Imaging CXCR4 expression in patients with suspected primary hyperaldosteronism

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