Percutaneous Adrenal Radiofrequency Ablation: A Short Review for Endocrinologists

Abstract

Image-guided radiofrequency ablation (RFA) has been accepted as a minimally invasive treatment for adrenal tumors in patients who are unable to undergo adrenalectomy. Accordingly, this treatment has become more readily available for treating functioning or non-functioning adrenal masses. Thus, endocrinologists need a better understanding of percutaneous RFA of adrenal tumors. The purpose of this review is to briefly describe the basic mechanism of RFA, indications and contraindications, patient preparation prior to RFA, type of complications, how to avoid complications, RFA procedures, and treatment outcomes.

Asian Conference on Tumor Ablation Guidelines for Adrenal Tumor Ablation

“…Nevertheless, the ability to achieve complete ablation and technical success is high, and complete ablation is between 92% and 96% can be expected to have a low complication rate [ 1 , 11 – 15 , 86 ]. This is a significant improvement from earlier series that showed a 79% technical success rate [ 13 ] for clinical outcomes associated with hormonally active adrenal tumors such as aldosteronoma, cortisol-secreting adenoma, and pheochromocytoma [ 6 , 87 – 92 ]. The majority of the current data is centered around RFA, with ablation of aldosteronomas being more commonly performed than the ablation of cortisol-secreting adenomas or pheochromocytomas [ 87 – 92 ].…”

“…Percutaneous biopsy is not necessary in patients with benign functioning masses prior to adrenal ablations unlike with renal, lung, or thyroid ablations because hormonal analysis alone can replace the invasive procedure to confirm the histologic diagnoses [ 2 , 6 ]. It is mandatory in patients with extra-adrenal malignancy to determine if an adrenal mass is a metastatic tumor.…”

“…The majority of the current data is centered around RFA, with ablation of aldosteronomas being more commonly performed than the ablation of cortisol-secreting adenomas or pheochromocytomas [ 87 – 92 ]. Short- and long-term resolution of biochemistry can range from between 90% to 100% (median, 100%) [ 6 , 87 – 92 ], and normalization of aldosterone, renin, and aldosterone to renin ratio can be achieved in almost all cases of aldosteronoma [ 87 – 90 , 92 ]. However, persistent hypertension can occur despite normalization of hormones [ 87 , 88 , 90 , 92 ].…”

“…Moreover, many kinds of ablation guidelines for these extra-adrenal organs have been established and updated for years. However, we only have several review articles that deal with adrenal ablation, but there is much overlap in terms of their content [ 1 – 6 ]. They have mainly focused on technical points only for those who are already used to interventional radiology.…”

The efficacy and safety of radiofrequency ablation in the treatment of inoperable patients with pulmonary malignant nodules

“…Imaging-guided radiofrequency ablation(RFA) has been proved to be effective in the treatment of liver tumors [5][6][7], More recently, it has been used to treat renal, adrenal, thyroid, and breast neoplasms [8][9][10][11]. RFA is a technique that relies on the delivery of RF energy through an electrode inserted in the tumor mass to generate a localised high temperatures eld that heats the target tissue, causing necrosis [12].…”