Repeat transcatheter adrenal ablation for recurrent aldosteronoma: a case report

This paper presents a successful case of recurrent aldosteronoma treated with repeat catheter-based adrenal ablation, and discusses the efficacy, safety, and recurrence management of this minimally invasive technique. A 35-year-old male with hypertension and refractory hypokalemia was diagnosed with primary aldosteronism (PA), confirmed by adrenal CT showing a right adrenal adenoma. The patient refused surgery and underwent initial catheter-based adrenal ablation in December 2020. After 28 months, recurrence occurred, and right-sided dominance was confirmed by adrenal venous sampling (AVS). A second ablation was performed in June 2023 using a "balloon-assisted embolization" technique to target the superior, middle, and inferior adrenal arteries. After the first ablation, aldosterone levels decreased, potassium normalized, and blood pressure improved; however, recurrence led to elevated aldosterone. The second ablation resulted in biochemical remission (aldosterone dropped from 99.6 ng/dL to 3.4 ng/dL, potassium stabilized) and blood pressure control (24-hour average blood pressure reduced from 185/128 mmHg to 130/82 mmHg). Follow-up at 22 months showed sustained efficacy. Imaging revealed reduced adrenal blood flow post-ablation. This case illustrates that catheter-based adrenal ablation is a safe and effective minimally invasive option for PA, particularly for patients declining surgery. Recurrence may relate to collateral circulation or vessel recanalization, and comprehensive ablation with stepwise techniques can enhance outcomes. This case highlights the potential of interventional management, but larger studies are needed for long-term validation.