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Computed Tomography-Guided Percutaneous Acetic Acid Injection Therapy for Functioning Adrenocortical Adenoma

Departments of Urology (S.M., T.F., H.K.) and Radiology (N.T., K.H.), International Medical Center of Japan, Tokyo 162-8655, Japan; and Department of Radiology (M.M.), Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan

Address all correspondence and requests for reprints to: Shigeru Minowada, Department of Urology, International Medical Center of Japan, 1-21-1, Toyama, Shinjuku-ku Tokyo, 162-8655, Japan. E-mail: sminowad{at}imcj.hosp.go.jp.

We reported the outcomes of computed tomography (CT)-guided percutaneous acetic acid injection therapy for functioning adrenocortical adenomas. With the patient in a prone position, the puncture needle was inserted vertically downward into the adenoma with frequent CT scanning. After confirmation by pilot injection with contrast medium, a small aliquot of 40–50% acetic acid was injected and repeated. Between 1997 and 2002, 18 sessions of CT-guided injection therapy, including one session of ethanol injection, were performed on 10 patients (five patients with primary aldosteronism and five patients with Cushing’s or subclinical Cushing’s syndrome) without any complications except transient upper abdominal pain during the acetic acid injection. The follow-up period ranged from 5–69 months. The treatment resulted in almost an extirpation of the adrenocortical hyperfunction in seven patients after one or two sessions. CT-guided percutaneous acetic acid injection might be a simple, cost-effective, and far less invasive treatment for small functioning adrenocortical adenomas.

Abbreviations: CT, Computed tomography; PAI, percutaneous acetic acid injection; PEI, percutaneous ethanol injection.

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