Percutaneous Bilateral Adrenal Radiofrequency Ablation in Severe Adrenocorticotropic Hormone-dependent Cushing Syndrome

Abstract

Objectives: The objectives of the study were to evaluate adrenal radiofrequency ablation (RFA) as a method of treatment in patients with severe adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome, among whom bilateral adrenalectomy is not a suitable option. Material and Methods: Five patients with ACTH-dependent Cushing syndrome underwent RFA of both adrenal glands. Four of them presented with Cushing disease unsuccessfully treated with pituitary surgery and medical therapy, while one patient had ACTH-dependent Cushing syndrome due to pancreatic endocrine tumor with liver metastases. All patients were disqualified from adrenalectomy due to morbid obesity or lack of consent. Results: A technical success was obtained in all cases, with only one re-intervention necessitated by a cooling effect of the inferior vena cava. Despite pre-procedural adrenergic blockade, severe hypertension was noted during the procedure in three cases, this being treated immediately using direct-acting vasodilators. No complications occurred otherwise. In all cases, significant improvement of clinical symptoms was observed, as well as marked decreases in levels of serum cortisol, free urine cortisol, and dehydroepiandrosterone sulfate. Conclusion: Bilateral RFA under CT-guidance is technically feasible and clinical improvement can be achieved using the method. In patients disqualified from adrenal surgery, RFA might be considered as an alternative method of ACTH-dependent Cushing syndrome treatment.

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

“…Developed AI postoperatively. Body weight reduction, blood pressure normalization, bone mineral density improvement at 18-24 months [12] . 48 Female CD 2020, Poland TSS (x1), Cyber Knife Radiofrequency ablation Serum cortisol decreased from 1001.4 to 267.6.…”

Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors

“…Furthermore, this review also found promising results for RFA and MWA in metastatic adrenal tumors, in which the presence of residual tumor following ablation was seen in <25% of cases with <25% recurrence rates [ 123 ]. RFA has also shown to be promising in patients with severe adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome for which bilateral adrenalectomy is not a suitable option [ 123 , 127 ]. A small case-series showed that all five patients who underwent bilateral RFA under CT-guidance had technical success with a resolution of their hypercortisolemia [ 127 ].…”

“…RFA has also shown to be promising in patients with severe adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome for which bilateral adrenalectomy is not a suitable option [ 123 , 127 ]. A small case-series showed that all five patients who underwent bilateral RFA under CT-guidance had technical success with a resolution of their hypercortisolemia [ 127 ].…”

Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future

“…In all patients, there was a resolution of hypercortisolaemia, as well as Cushingoid clinical features following ablation. However, there is no long-term follow-up of disease recurrence [ 69 ]. Adrenal thermal ablation of phaeochromocytoma has had variable success.…”

“…High quality supporting evidence for the use of adrenal ablation is not yet available and as such randomized controlled trials and direct head-to-head comparisons with surgery are necessary to fully evaluate its benefit. Undoubtedly thermal ablation offers promise to increase the scope for delivery of definitive therapy for adrenal endocrinopathies in unilateral and perhaps bilateral disease [ 24 ▪▪ , 69 , 79 ]. However, significant challenges remain in the development of the technology.…”