Small Functional Adrenal Cortical Adenoma: Treatment with CT-guided Percutaneous Acetic Acid Injection—Report of Three Cases

Liang, Huei‐Lung; Pan, Huay-Ban; Lee, Y.-H.; Huang, Jen‐Chieh; Wu, Tien-Yu; Chang, Chiz‐Tzung; Yang, Tsen-Long; Yang, Chien-Fang

doi:10.1148/radiology.213.2.r99nv10612

Cited by 36 publications

(17 citation statements)

References 12 publications

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“…Due to their small size with a diameter of less than 5 cm, cortisol-secreting adrenal adenomas are very suitable for endoscopic surgical techniques. An alternative therapeutic option is the treatment with CT-guided percutaneous acetic acid injections, but to date this treatment option has only been reported in a limited number of cases [26]. Thus, drug therapy should not be deployed as a definitive treatment in the case of patients eligible for an operative procedure, but only in order to improve the preoperative condition.…”

Section: Discussionmentioning

confidence: 99%

Cushing’s Syndrome: Adrenalectomy and Long-Term Results

Meyer

Behrend

2004

Dig Surg

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Background: The objective of this study was to assess the preoperative symptoms, intra- and postoperative complications and follow-up in patients after uni- or bilateral adrenalectomy due to Cushing’s syndrome (CS), independent of etiology. Methods: Clinical charts of 42 patients (5 with ACTH-dependent, 37 with ACTH-independent CS) were reviewed, and follow-up data were obtained from re-examination of the patients. Results: The symptoms most frequently seen were hypertension, changes of the skin and obesity. Eight bilateral and 36 unilateral adrenalectomies were carried out without any intraoperative complications. Postoperative complications occurred in 5 patients, 1 patient died on the fourth postoperative day. After a mean duration of 4.6 years 28 of 41 patients could be re-examined, 5 patients had died. One patient showed recurrence 4.3 years after unilateral adrenalectomy due to nodular hyperplasia, contralateral adrenalectomy again revealed nodular hyperplasia. Conclusion: Early diagnosis is essential in order to decrease the rate of pre-, intra- and postoperative complications. Endoscopic approach should be taken in a specialized center due to poor patient’s condition. Recurrent disease on the contralateral side may represent bilateral adrenal hyperplasia with sequential tumor formation, demonstrating the importance of extensive preoperative biochemical and imaging testing and close follow-up.

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Section: Discussionmentioning

confidence: 99%

Cushing’s Syndrome: Adrenalectomy and Long-Term Results

Meyer

Behrend

2004

Dig Surg

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“…7,9 Recently, an increasing number of minimally invasive treatments, such as selective arterial embolization, radiofrequency ablation, chemical ablation, laser ablation, and microwave ablation, have been used to treat adrenal carcinoma. [10][11][12][13][14][15][16] Microwave ablation has been developed in the current decade as a new tumor ablation technique and is widely used to treat many types of malignant carcinomas including liver cancer, lung cancer, metastatic bone tumors, and renal tumors. [16][17][18][19][20] Microwave ablation of the adrenal gland is a promising technique for percutaneous treatment of adrenal malignant tumors, although there is limited experience reported in the literature.…”

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confidence: 99%

CT‐guided percutaneous microwave ablation of adrenal malignant carcinoma

Fan

Zhang

et al. 2011

Cancer

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BACKGROUND:Microwave ablation has recently been developed as a safe and effective treatment for a variety of tumors. The authors evaluated the safety and efficacy of computed tomography (CT)‐guided percutaneous microwave ablation of adrenal malignant tumors.METHODS:Nine patients between 41 and 83 years of age (average age, 54 years) with adrenal carcinoma (a total of 10 lesions) received CT‐guided percutaneous water‐cooled microwave ablation. The 9 cases included 1 primary adrenocortical carcinoma and 8 metastatic carcinomas (4 from lung cancer, 2 from hepatocellular carcinoma, 1 from intrahepatic cholangiocarcinoma, and 1 from left tibial osteosarcoma). Of the 8 metastatic cases, 7 were unilateral, and 1 was bilateral. All cases were pathologically confirmed by aspiration biopsy or postsurgical biopsy. The tumor diameters ranged from 2.1 cm to 6.1 cm (average, 3.8 cm). The average number of ablation sites was 1.5 sites (1‐3 sites), and the average accumulated ablation time was 7.7 minutes (4‐15 minutes). The procedures were performed using a cooled‐shaft antenna.RESULTS:The patients were followed for 3‐37 months, with an average of 11.3 months. Nine of 10 lesions were completely necrotized after first treatment. The other lesion was completely necrotized after 2 treatments. One of the patients experienced hypertensive crisis during treatment. No patient experienced recurrent tumor at the treated site, and this lack of recurrence indicated effective local control. All patients had progression of metastatic disease at extra‐adrenal sites.CONCLUSIONS:CT‐guided percutaneous water‐cooled microwave ablation is a minimally invasive and effective method for the treatment of adrenal carcinoma. Cancer 2011;. © 2011 American Cancer Society.

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“…Similarly, Liang et al [24] reported CT-guided chemical ablation using acetic acid for three functional adrenal masses-two aldosterone-and one cortisol-producing tumors. At 1-year follow-up, all three tumors had regressed radiographically with complete cystic changes, and all three patients were asymptomatic with normal laboratory values.…”

Section: Chemical Ablationmentioning

confidence: 97%

Needlescopic ablation of small adrenal masses

Lauer

Pizzo²,

Raman

2009

Curr Urol Rep

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Needlescopic adrenal ablative therapy is an attractive therapeutic option for the management of small adrenal masses. The spectrum of neoplasms that can be ablated includes isolated solid organ metastases (lung, kidney, liver), nonisolated but symptomatic (painful) adrenal metastasis, and small, nonmetastatic, hormonally active adrenal tumors. Moreover, needlescopic ablation offers an effective minimally morbid intervention for patients who are poor surgical candidates either due to advanced age and/or significant comorbid conditions. Ablative techniques described to date include radiofrequency ablation (RFA), cryoablation, and chemical ablation. Most procedures can be performed under percutaneous radiographic guidance on an outpatient basis. By and large, the bulk of clinical experience with adrenal ablation pertains to RFA. Successful ablation is usually dependent upon lesion size, with tumors 5 cm or smaller demonstrating the highest successful ablation rates. The most frequently described adverse sequelae of adrenal ablation are local tumor recurrences. However, many of these local recurrences can be managed by repeat ablation, with patients demonstrating durable oncologic outcomes.

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Small Functional Adrenal Cortical Adenoma: Treatment with CT-guided Percutaneous Acetic Acid Injection—Report of Three Cases

Cited by 36 publications

References 12 publications

Cushing’s Syndrome: Adrenalectomy and Long-Term Results

Cushing’s Syndrome: Adrenalectomy and Long-Term Results

CT‐guided percutaneous microwave ablation of adrenal malignant carcinoma

Needlescopic ablation of small adrenal masses

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