The interventional radiology consultation.

The visit was pretty routine, she explained the AVS procedure to me and told me what to expect. I did learn that at UCLA, they *always* use ACTH for AVS, and they *always* do AVS before adrenalectomy in all PA cases, even those who are under 40 years old. These are two areas of controversy within the greater PA community, and I was reassured to hear this. Even if I was under 40, I would want the AVS, as it is the only way to determine if the disease is unilateral or bilateral. I really wouldn’t want to undergo surgery only to be told, “Whoops, sorry, you still have to take meds for the rest of your life.”

The interventional radiologist commented that based on my CT scan images alone, she seconds my nephrologist’s opinion that the appearance of my left adrenal looks like textbook unilateral PA. Apparently the entire adrenal gland is enlarged, whereas my right one is normal sized.

She claims to have done dozens of AVS procedures, one as recently as two weeks ago. The main complication she has encountered is the inability to access the right adrenal and get a good blood sample. In most cases, this means the procedure has to be repeated, but in some cases it’s impossible to access the right adrenal. If If turn out to be one of those, if the levels they get on my left are off-the-charts high as they have been so far, her recommendation would be to proceed directly to surgery.

I think I’m in good hands. This might sound silly, but the fact that I really liked her makes me feel a lot more comfortable about going through with this. She made a couple jokes and laughed at my own wisecracks, and something about that really helped. It’s hard for me not to trust someone who has a good sense of humor 🙂

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