Transcatheter adrenal ablation for metastatic carcinoma of the breast

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Adrenal insufficiency has been reported following diagnostic adrenal venography. In 1965 Starer1 reported that only one of his eight patients had adrenal hemorrhage, but there was no permanent abnormality. In 1970 Bayliss et al2 reviewed 363 cases and found only 10 with adrenal hemorrhage. Of 80 cases reported by Mitty et al,3 only five had extravasation, but none had prolonged symptoms or persistent hypoadrenalism.

During this time, cases were also reported which indicated that some patients could suffer permanent hypoadrenalism from adrenal venography and adrenal hemorrhage. The vast majority of these cases were patients with adrenal pathology.4–9 A new twist was added in 1971 when Lecky and Plotkin10 reported the intentional bilateral ablation of the adrenal glands in a patient with metastatic cancer. After the ablation, the patient had normal baseline studies while taking steroid replacement, but there was no response to corticotropin infusion. Others have also reported the intentional bilateral adrenal ablation in patients with ectopic ACTH syndrome.11–12

In 1972 one of the authors (T.F.M.) performed an adrenal venogram for the diagnosis and localization of a suspected aldosterone tumor of the adrenal gland. Adrenal venous samples were initially obtained for the purpose of assay for aldosterone, and following this selective angiography of the right adrenal vein resulted in inadvertent rupture. Assay of the venous samples obtained from the right adrenal vein showed high levels of aldosterone. After the procedure, the clinical signs and laboratory values indicative of an excess of aldosterone disappeared and have not recurred during . . .



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