A Case of Cushing Syndrome Successfully Treated with Superselective Adrenal Arterial Embolization of an Adrenocortical Adenoma with a 6-Month Follow-Up

Abstract

ABSTRACT: Objective: Cushing syndrome is a disease characterized by a state of hypercortisolism, resulting in significant morbidity and mortality. Early diagnosis and treatment are essential. We report a very challenging case of adrenal Cushing syndrome that was successfully treated with superselective adrenal embolization. Methods: Case report and review of the literature. Results: A 35-year-old patient with Cushing syndrome secondary to a 3.5 × 2.7 cm left, lipid-rich adrenocortical adenoma presented to our hospital with a septic shock due to necrotic pancreatitis and peri-pancreatic abscess. Patient was managed medically first, then underwent open laparotomy, but the left adrenal gland could not be accessed due to extensive fibrosis and inflammation. She ultimately underwent left adrenal superselective arterial embolization using polyvinyl alcohol and microcoils. Biochemical and clinical remission were achieved. Computed tomography scan of the abdomen 4 months later revealed remarkable regression of the adenoma size (2.0 × 2.1 cm). Conclusion: While surgery is the treatment of choice for Cushing syndrome due to adrenocortical adenoma, adrenal artery embolization could be considered when surgery is not an option.