Percutaneous ablation of functioning adrenal adenoma: a report on 11 cases and a review of the literature

Nunes, Thiago Franchi; Szejnfeld, Dênis; Xavier, Ana Carolina Wanderley; Kater, Cláudio E.; Freire, Fabio; Ribeiro, Cassio Andreoni; Goldman, Suzan Menasce

doi:10.1007/s00261-013-9995-6

Cited by 30 publications

(29 citation statements)

References 19 publications

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“…Radiofrequency ablation (RFA) has recently emerged as a new treatment for primary alosteronism. In 2010, the investigators of the present study reported on the feasibility of CT‐guided percutaneous RFA in 24 patients with APA.…”

Section: Introductionmentioning

confidence: 85%

“…Treatment with RFA was not without risks. Retroperitoneal haematoma was the most common complication, probably because the adrenal gland is highly vascularized. Retroperitoneal haematomas were often non‐expanding and asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…At a median follow‐up of 25·5 months, RFA had induced remission of primary aldosteronism and resolution of hypertension in 96 and 67 per cent of patients respectively. Several smaller series have demonstrated a high short‐term cure rate after treatment with RFA in patients with primary aldosteronism. A comparative study between surgery and RFA in patients with APA is lacking.…”

Section: Introductionmentioning

confidence: 99%

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Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma

Liu

Chu

Kong

et al. 2016

Journal of British Surgery

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Section: Introductionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma

Liu

Chu

Kong

et al. 2016

Journal of British Surgery

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“…Traditionally, evaluation, management and clinical sequalae for hypertensive urgency are based on longer periods of exposure (>30 min), and so the clinical significance of transient hypertension in these patients is unclear. The prophylactic use of anti-adrenergic agents for several weeks prior to ablation in practice and existing literature for adrenal adenomas is variable 16,2716,2614,21 . In consultation with the anesthesiology department peri-procedural rather than prophylactic control was adopted in this study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma: Comparison with Adrenalectomy

Sarwar

Brook

Vaidya

et al. 2016

Journal of Vascular and Interventional Radiology

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Purpose To compare the efficacy of adrenal radiofrequency ablation (RFA) in treating unilateral aldosterone producing adenomas (APA) with adrenalectomy. Materials and Methods Between 04/2008–09/2013, 44 patients with adrenal venous sampling confirmed (lateralization index ≥ 4) unilateral APA underwent adrenal RFA (12/44 [27%]) or adrenalectomy (32/44 [73%]). Outcomes of patients treated with adrenal RFA (51±11 years, 4/12 male) were compared to patients treated with adrenalectomy (50±11 years, 19/32 male). Pre-treatment blood pressure (145±19/94±13 vs. 144±10/89±8; p=0.92), number of anti-hypertensives (3.0 ±1.3 vs. 2.7±0.89; p=0.38) and serum potassium (3.2±0.6 vs. 3.5±0.6 mEq/L; p=0.65) of RFA and adrenalectomy patients were similar. Results Both RFA and adrenalectomy resulted in post-procedural normokalemia (RFA: 4.2±0.1 mEq/L; p=0.0004 vs. adrenalectomy: 4.3±0.6 mEq/L; p<0.0001) and normotension (RFA: 129±11/81±11 mmHg; p=0.02/0.001 vs. adrenalectomy: 128±13/85±12; p<0.0001/p=0.07) in all patients. Proportions of RFA and adrenalectomy patients cured of hypertension (2/12 (17%) vs. 12/32 (38%), p=0.28) or requiring fewer anti-hypertensives (7/12 (58%) vs. 13/32 (40%), p=0.29) was similar. RFA patients had a shorter length of stay (0.6±0.8d [Range: 0–2d] vs. 1.7±1.4d [0–7d], p=0.01) and lower intra-operative blood loss (1.2±3ml vs. 40±85ml, p=0.01) compared to adrenalectomy patients. Procedural complications occurred in 5/32 (15%) adrenalectomy patients (2 major, 3 minor) and in none of the RFA patients. Conclusion RFA to treat APA can achieve clinical outcomes that approach adrenalectomy but result in shorter hospital stays. Larger, prospective trials are needed to validate these results.

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“…11,12 These techniques are less invasive than surgery, but the long-term outcome and risks are uncertain. They should therefore be used only within the confines of a study protocol.…”

Section: Unilateral Adrenalectomymentioning

confidence: 99%

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

Steichen

Lorthioir

Zinzindohoué

et al. 2015

Advances in Chronic Kidney Disease

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Treatments for primary aldosteronism (PA) aim to correct or prevent the deleterious consequences of hyperaldosteronism: hypertension, hypokalemia and direct target organ damage. Patients with unilateral PA considered fit for surgery can undergo laparoscopic adrenalectomy, which significantly decreases blood pressure and medications in most cases, and cures hypertension in about 40%. Mineralocorticoid receptor antagonists (MRA) are used to treat patients with bilateral PA and those with unilateral PA if surgery is not possible or not desired. Spironolactone is more potent than eplerenone, but high doses are poorly tolerated in men. MRA can be replaced or complemented with epithelial sodium channel blockers, such as amiloride. Thiazide diuretics and calcium channel blockers are used when the first-line drugs are insufficient to control blood pressure. Dietary sodium restriction should be implemented in all cases, because the deleterious consequences of hyperaldosteronism are dependent on salt loading. Several studies comparing the results of surgery and MRA have reported no differences in terms of blood pressure, serum potassium concentration or cardiovascular and renal outcomes, although the benefits of treatment tend to be observed sooner with surgery.PA patients display relative glomerular hyperfiltration, which is reversed by specific treatment, revealing chronic kidney disease in 30% of patients. However, further kidney damage is prevented by the treatment of PA. Clinical summary-The goals of treatment are the normalization of serum potassium concentration, blood pressure control and prevention of the direct effects of excess aldosterone on target organs. 3-The non-surgical treatment of PA is based on mineralocorticoid receptor antagonists and dietary sodium restriction.-Epithelial sodium channel blockers are used when mineralocorticoid receptor antagonists are not well tolerated; thiazide diuretics and calcium channel blockers are used when blood pressure control is insufficient with the first-line treatment.-Laparoscopic adrenalectomy is safe and decreases BP and medication requirements in patients with unilateral PA; drug-based treatments are appropriate in cases in which surgery is inappropriate or not desired.

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Percutaneous ablation of functioning adrenal adenoma: a report on 11 cases and a review of the literature

Abstract: CT-guided percutaneous RFA was a safe and effective treatment for functioning adrenal adenomas, with short hospital length of stay and low complication rate.

Cited by 30 publications

References 19 publications

Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma

Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma

Clinical Outcomes following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma: Comparison with Adrenalectomy

Outcomes of Drug-Based and Surgical Treatments for Primary Aldosteronism

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