Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders

Abstract

OBJECTIVES:To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders.METHOD:We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years.RESULTS:Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients.CONCLUSION:Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.

Utilization of bilateral percutaneous microwave ablation of the adrenal glands in ectopic Cushing's syndrome

“…As in our case, nearly all patients had already failed conventional therapy prior to undergoing bilateral adrenal ablation. Most patients had a good response after the procedure with only 1 patient out of 11 who had undergone bilateral alcohol ablation failing to show significant decrease in cortisol levels and required medical treatment afterward [11] . One patient who underwent MWA responded to therapy, but then underwent surgical bilateral adrenalectomy after improving clinically [4] .…”

“…Body weight reduction at 18-24 months [12] . 38 Female CD 2016, Brazil TSS (x1), radiotherapy Percutaneous ethanol ablation Failed to respond and required continued medical treatment [11] . 70 Male Ectopic ACTH, pancreatic NET 2020, Poland Liver surgery and PRRT Radiofrequency ablation Serum cortisol decreased from 1727 to 441.…”

The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Management of Metastatic and/or Unresectable Pheochromocytoma and Paraganglioma

“…Based on limited data, we recommend the use of periprocedural α-blockade for 7 to 14 days before biopsy procedures (usually for an unrelated non-PPGL reason), radiofrequency ablation (RFA), 85,86 cryoablation, microwave ablation, 87 and chemoembolization procedures. [88][89][90] α-Blockade should be continued for 3 days after the procedure for those with nonsecreting tumors who were not already taking daily α-blockade. 85 α-Blockade should also be used with chemotherapy and systemic therapies, particularly with the use of tyrosine kinase inhibitors (TKIs); however, the duration of blocking is not well defined.…”

“…Injection of PCC was associated with major hemodynamic adverse events. 88 Chemical ablation is also not recommended for this disease.…”