Therapeutic consequence of adrenal venous sampling complication: remission of primary aldosteronism after adrenal vein thrombosis.

A 43-year-old man with resistant hypertension and hypokalemia was diagnosed with primary aldosteronism (PA), confirmed by biochemical testing and adrenal vein sampling (AVS), which lateralized aldosterone secretion to the right adrenal gland. Shortly after AVS, he developed right flank pain, and imaging showed mild postprocedural changes without overt complications. Three months later, he presented with hyperkalemia and acute kidney injury, but notably, his blood pressure had improved with fewer antihypertensives. Laboratory evaluation revealed suppressed aldosterone, normal renin, and no evidence of catecholamine excess. Imaging and hormonal reassessment suggested spontaneous resolution of PA. Despite plans for adrenalectomy based on initial AVS results, surgery revealed a thrombosed right adrenal vein and infarcted adrenal tissue. Histopathology confirmed hemorrhagic infarction with chronic inflammation. This rare case highlights adrenal vein thrombosis during AVS, inducing an acute, transient biochemical remission of PA via infarction of the aldosterone-producing gland. It underscores the importance of vigilant post AVS monitoring and recognition that procedural complications, while uncommon, may yield unexpected therapeutic benefit in select patients.