ABSTRACT
A 54-year-old woman presented with a history of nausea, vomiting, diarrhea, and recurrent episodes of severe hypokalemia requiring hospitalization. Imaging revealed a pancreatic mass with liver metastases, histologically confirmed to be a neuroendocrine tumor. Elevated active renin and aldosterone levels were identified, and the patient was treated with 4 induction cycles of Lu-DOTATATE, which resolved the diarrhea, nausea, and hypokalemia, and normalized the renin and aldosterone levels. After 3 additional maintenance Lu-DOTATATE treatments, the pancreatic tumor had decreased in size, was deemed operable, and was resected. She remains on maintenance Lu-DOTATATE therapy with progression-free survival of 45 months thus far.
Subject(s)
Hyperaldosteronism/radiotherapy , Hypokalemia/radiotherapy , Liver Neoplasms/pathology , Neuroendocrine Tumors/radiotherapy , Octreotide/analogs & derivatives , Organometallic Compounds/therapeutic use , Pancreatic Neoplasms/radiotherapy , Radiopharmaceuticals/therapeutic use , Female , Humans , Liver Neoplasms/diagnostic imaging , Middle Aged , Neuroendocrine Tumors/diagnostic imaging , Neuroendocrine Tumors/secondary , Octreotide/therapeutic use , Pancreatic Neoplasms/diagnostic imaging , Pancreatic Neoplasms/secondary , Radionuclide ImagingABSTRACT
The authors describe a new method of X-ray endovascular destruction of the adrenal in patients with arterial hypertension and hyperaldosteronism. Destruction of the adrenal is accomplished by acute occlusion of its venous channel by introduction of a 3% thrombovar solution through a catheter installed in the central vein of the suprarenal gland. This method was applied in 22 patients with arterial hypertension; essential hypertension with secondary hyperaldosteronism was found in 18 of them, renoparenchymatous hypertension in 2, aldosteroma of the left adrenal in one, and Itsenko-Cushing's disease in one patient. Acute occlusion of the adrenal venous channel was achieved in 20 patients. The intervention normalized blood pressure in 16 and reduced it significantly in 4 patients.