Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma

Liu, S Y; Chu, Cheuk Man; Kong, Alice Pik Shan; Wong, SK; Chiu, Philip Wai Yan; Chow, Francis C. C.; Ng, Enders K.

doi:10.1002/bjs.10219

Cited by 34 publications

(39 citation statements)

References 49 publications

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“…Management of primary aldosteronism is rapidly changing as less invasive modalities become available for diagnosis and treatment of functional adenomas. 35 …”

Section: Discussionmentioning

confidence: 99%

Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies

Williams

MacDonald

Morant

et al. 2018

The Lancet Diabetes & Endocrinology

215

132

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SummaryBackgroundIn the PATHWAY-2 study of resistant hypertension, spironolactone reduced blood pressure substantially more than conventional antihypertensive drugs. We did three substudies to assess the mechanisms underlying this superiority and the pathogenesis of resistant hypertension.MethodsPATHWAY-2 was a randomised, double-blind crossover trial done at 14 UK primary and secondary care sites in 314 patients with resistant hypertension. Patients were given 12 weeks of once daily treatment with each of placebo, spironolactone 25–50 mg, bisoprolol 5–10 mg, and doxazosin 4–8 mg and the change in home systolic blood pressure was assessed as the primary outcome. In our three substudies, we assessed plasma aldosterone, renin, and aldosterone-to-renin ratio (ARR) as predictors of home systolic blood pressure, and estimated prevalence of primary aldosteronism (substudy 1); assessed the effects of each drug in terms of thoracic fluid index, cardiac index, stroke index, and systemic vascular resistance at seven sites with haemodynamic monitoring facilities (substudy 2); and assessed the effect of amiloride 10–20 mg once daily on clinic systolic blood pressure during an optional 6–12 week open-label runout phase (substudy 3). The PATHWAY-2 trial is registered with EudraCT, number 2008–007149–30, and ClinicalTrials.gov, number NCT02369081.FindingsOf the 314 patients in PATHWAY-2, 269 participated in one or more of the three substudies: 126 in substudy 1, 226 in substudy 2, and 146 in substudy 3. Home systolic blood pressure reduction by spironolactone was predicted by ARR (r2=0·13, p<0·0001) and plasma renin (r2=0·11, p=0·00024). 42 patients had low renin concentrations (predefined as the lowest tertile of plasma renin), of which 31 had a plasma aldosterone concentration greater than the mean value for all 126 patients (250 pmol/L). Thus, 31 (25% [95% CI 17–33]) of 126 patients were deemed to have inappropriately high aldosterone concentrations. Thoracic fluid content was reduced by 6·8% from baseline (95% CI 4·0 to 8·8; p<0·0001) with spironolactone, but not other treatments. Amiloride (10 mg once daily) reduced clinic systolic blood pressure by 20·4 mm Hg (95% CI 18·3–22·5), compared with a reduction of 18·3 mm Hg (16·2–20·5) with spironolactone (25 mg once daily). No serious adverse events were recorded, and adverse symptoms were not systematically recorded after the end of the double-blind treatment. Mean plasma potassium concentrations increased from 4·02 mmol/L (95% CI 3·95–4·08) on placebo to 4·50 (4·44–4·57) on amiloride (p<0·0001).InterpretationOur results suggest that resistant hypertension is commonly a salt-retaining state, most likely due to inappropriate aldosterone secretion. Mineralocorticoid receptor blockade by spironolactone overcomes the salt retention and resistance of hypertension to treatment. Amiloride seems to be as effective an antihypertensive as spironolactone, offering a substitute treatment for resistant hypertension.FundingBritish Heart Foundation and UK National Institute for Health Resea...

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“…Management of primary aldosteronism is rapidly changing as less invasive modalities become available for diagnosis and treatment of functional adenomas. 35 …”

Section: Discussionmentioning

confidence: 99%

Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies

Williams

MacDonald

Morant

et al. 2018

The Lancet Diabetes & Endocrinology

215

132

View full text Add to dashboard Cite

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“…Percutaneous RFA provides excellent clinical and hormonal outcomes for patients with functional benign adrenal masses such as aldosteronoma, cortisol-secreting adenoma, and pheochromocytoma (Table 1) [11,[14][15][16][17]19,20]. The most common functioning benign tumor treated is aldosteronoma.…”

Section: Rfa Outcomesmentioning

confidence: 99%

“…The most common functioning benign tumor treated is aldosteronoma. The number of cortisol-secreting adenomas or pheochromocytomas treated with RFA is much smaller than that of aldosteronomas [14][15][16][17]19,20]. Short-and long-term bio-chemical resolution have ranged from 90% to 100% (median, 100%) (Table 1) [11,[14][15][16][17]19,20].…”

Section: Rfa Outcomesmentioning

confidence: 99%

“…The number of cortisol-secreting adenomas or pheochromocytomas treated with RFA is much smaller than that of aldosteronomas [14][15][16][17]19,20]. Short-and long-term bio-chemical resolution have ranged from 90% to 100% (median, 100%) (Table 1) [11,[14][15][16][17]19,20]. Normalization of aldosterone, renin, and aldosterone to renin ratio have been achieved in almost all cases of aldosteronoma [14][15][16][17]20].…”

Section: Rfa Outcomesmentioning

confidence: 99%

“…Percutaneous thermal ablation is a minimally invasive treatment for liver [1,2], kidney [3,4], lung [5,6], bone [7,8], and thyroid [9,10] tumors in patients who are unable to undergo surgery. This treatment also has been used to treat adrenal tumors in patients who are poor surgical candidates [11][12][13][14][15][16][17][18][19][20][21][22][23]. Thermal ablation techniques for adrenal ablation include radiofrequency ablation (RFA), cryoablation [24,25], and microwave ablation [26,27].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Percutaneous Adrenal Radiofrequency Ablation: A Short Review for Endocrinologists

Park

2020

Endocrinol Metab

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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.

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Ablation versus laparoscopic adrenalectomy for the treatment of aldosterone‑producing adenoma: a meta-analysis

Chen

Zhu

et al. 2021

Abdom Radiol

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Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma

Abstract: For patients with aldosterone-producing adenoma the efficacy of resolution of primary aldosteronism and hypertension was inferior after treatment with RFA compared with laparoscopic adrenalectomy.

Cited by 34 publications

References 49 publications

Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies

Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies

Percutaneous Adrenal Radiofrequency Ablation: A Short Review for Endocrinologists

Ablation versus laparoscopic adrenalectomy for the treatment of aldosterone‑producing adenoma: a meta-analysis

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