Superselective Adrenal Artery Embolization as a Novel Alternative Treatment for Aldosterone-Producing Adenomas: A Case of Refractory Hypertension With Concomitant Autonomous Cortisol Secretion

Abstract

Primary aldosteronism (PA) is characterized by an overproduction of aldosterone, leading to hypertension and hypokalemia. Although surgery is an effective treatment for unilateral PA, some patients may be unwilling or unable to undergo this invasive procedure. This case report presents a 51-year-old female patient with refractory hypertension, diagnosed with right-sided hypersecretion of aldosterone and concomitant with autonomous cortisol secretion. The patient declined surgery and was treated with spironolactone as an alternative. Despite optimized medication over 3 months, her blood pressure remained poorly controlled, and she continued to experience hypokalemia and muscle weakness. The patient subsequently underwent right-sided superselective adrenal artery embolization (SAAE). The procedure led to significant reductions in aldosterone and cortisol levels, achieving long-term blood pressure control and biochemical remission with minimal doses of antihypertensive drugs and no need for potassium supplementation. Two years of follow-up confirmed sustained clinical and biochemical improvements, along with evidence of ameliorated target organ damage. This case highlights the potential of SAAE as a feasible treatment option for aldosterone-producing adenomas, offering an alternative therapeutic approach beyond current guidelines.