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

Abstract

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.

Outcomes in unilateral primary aldosteronism after surgical or medical therapy

“…In 13.2% of our patients, MR antagonists had to be stopped in view of progressive renal disease or hyperkalaemia. In the future, use of functional imaging such as 11C‐metomidate PET‐CT, 33 to identify the exact site of aldosterone excess, coupled with newer treatment modalities like radiofrequency ablation, 34,35 may potentially provide a treatment pathway for bilateral adrenal nodules. Nevertheless, this may not be possible for patients with bilateral adrenal hyperplasia.…”

Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study

“…Previous series of RFA for APA treatment have been already published in which BP improvement varied widely from 17 to 67%. All but one retrospective comparison between RFA and adrenalectomy suggested no differences in BP control [ 21 , 23 , 24 , 32 ]. Liu et al [ 32 ] reported that hypertension was less frequently cured after RFA than after surgery (36 vs. 70%; P = 0.007).…”

“…Several factors contribute to explain the discrepancy between our results and those reported in other studies (Supplemental digital content 4). The main one is that we used ABPM, which is the gold standard to measure BP in a much more robust manner than casual measurements reported elsewhere [ 18 , 20 , 21 , 23 , 24 , 32 ].…”

An Individualized Approach to The Evaluation and Management of Primary Aldosteronism

“…Although not widely practiced, a more recent option that is becoming available is radiofrequency ablation of adrenal adenomas. Small studies have shown similar rates of hypertensive cure or improvement and similar rates of complications and hospital length of stay, suggestive that ablative techniques may represent a potential nonsurgical alternative for the treatment of unilateral PA (37,38). One minor limitation to radiofrequency ablation is the inability to collect histopathology; therefore, these procedures should only be considered when radiography is strongly suggestive of a benign cause of PA.…”