Adrenal artery ablation for primary aldosteronism without apparent aldosteronoma: An efficacy and safety, proof‐of‐principle trial

Abstract

Primary aldosteronism (PA) is associated with resistant hypertension and cardiovascular events. There are some limitations of current medical and surgical therapies for PA. To determine the efficacy and safety of catheter‐based adrenal artery ablation for treatment of PA patients who refused both surgery and medical therapy, we performed this prospective cohort study. Thirty‐six PA patients without apparent aldosteronoma were treated by adrenal artery ablation. Primary outcome was postoperative blood pressure and defined daily dose (DDD) of antihypertensive medications after adrenal ablation. Secondary outcome was biochemical success. We assessed outcomes based on Primary Aldosteronism Surgical Outcome (PASO) criteria. Adrenal CT scan, biochemical evaluation, adrenal artery ablation and adrenal venous sampling (AVS) were underwent. After adrenal ablation, complete clinical success (normotension without antihypertensive medication) was achieved in 9/36 (25.0%) patients and partial clinical success (reduction in blood pressure or less antihypertensive medication) in 13/36 (36.1%) patients. Complete biochemical success (correction of hypokalemia and normalization of aldosterone‐to‐renin ratio) was achieved in 16/36 (44.4%) patients. Office‐based and ambulatory blood pressures were reduced by 17/7 and 11/2 mmHg at 6 months after ablation, respectively. The plasma cortisol level in the ablation group decreased slightly, but no patient developed hypoadrenocorticism. Catheter‐based adrenal ablation appears to produce substantial and sustained blood pressure reduction and biochemical improvement, with only minor adverse events in PA patients without apparent aldosteronoma. This therapy could be an important supplement for current PA treatments.

Japan Endocrine Society clinical practice guideline for the diagnosis and management of primary aldosteronism 2021

“…Although laparoscopic adrenalectomy is the standard surgical treatment for APA, various treatments have been developed for reducing invasiveness: minimally invasive partial adrenalectomy [186], robot-assisted partial adrenalectomy [187], radiofrequency ablation for adrenal adenomas [188], and adrenal artery ablation [189], respectively. These new techniques are expected as an alternative treatment when patients have no desire for surgery or under general anesthesia is not indicated.…”

Clinical Characteristics of Target Organ Damage in Primary Aldosteronism with or without Metabolic Syndrome

“…AVS was performed in all patients without adrenocorticotropic hormone simulation, and this was performed as described in our previous study [ 18 ]. Sampling was regarded as successful when the selectivity index (SI, defined as cortisol in the adrenal vein/cortisol) was ≥2.…”

“…Thus, adrenal venous sampling (AVS) is used as the gold standard for aldosterone lateralization [17]. In our previous study, we also found a 50% inconsistency rate between CT and AVS among 32 cases [18]. Therefore, the aim of our present study was to examine the prevalence of metabolic disorders in different subtypes of patients with PA diagnosed via AVS, as well as to determine whether the presence of MS aggravates the severity of organ damage.…”

Adrenal ablation therapy for unilateral primary aldosteronism: pros and cons

“…The Chongqing Endocrine Hypertension Collaborative Team conducted several other studies. Zhang et al [12] reported a prospective cohort study of catheter-based adrenal ablation in 36 PA patients without apparent aldosteronoma. Complete and partial clinical success was achieved in 9 (25.0%) and 13 (36.1%) patients, respectively.…”