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Duplicate inferior vena cava complicating the evaluation of primary aldosteronism

Graham J Spurzem1, Michael A Taddonio2, Tamara T Rubenzik3

  • 1Surgery, University of California San Diego School of Medicine, La Jolla, California, USA gspurzem@health.ucsd.edu.

BMJ Case Reports
|January 19, 2021
PubMed

Insights

A patient with resistant hypertension and a rare duplicate inferior vena cava (D-IVC) underwent successful adrenalectomy for primary aldosteronism. Awareness of venous anatomical variants is crucial for invasive procedures.

Area of Science:

  • Endocrinology
  • Vascular Surgery
  • Radiology

Background:

  • Resistant hypertension and hypokalemia can indicate primary aldosteronism.
  • Duplicate inferior vena cava (D-IVC) is a rare congenital anomaly of the abdominal venous system.
  • Accurate diagnosis and management of primary aldosteronism require precise anatomical knowledge.

Observation:

  • A 64-year-old male presented with hypertensive crisis, resistant hypertension, and hypokalemia.
  • Abdominal MRI revealed a left adrenal adenoma, and adrenal venous sampling (AVS) confirmed left-sided aldosterone hypersecretion.
  • The patient had a known D-IVC, a rare anatomical variant.

Findings:

  • Laparoscopic left adrenalectomy was performed successfully, despite the D-IVC.
  • Postoperatively, the patient's hypertension resolved, requiring only one antihypertensive medication.
  • The patient was discharged on postoperative day 1 with an excellent outcome.

Implications:

  • Knowledge of rare venous anatomical variants like D-IVC is essential for planning and executing invasive procedures such as AVS.
  • Successful management highlights the importance of integrating anatomical variations into clinical decision-making for endocrine surgery.
  • This case underscores the need for vigilance regarding abdominal venous anomalies in patients undergoing evaluation for primary aldosteronism and related interventions.

Keywords:
adrenal disordersinterventional radiologysurgical oncology

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