Radiofrequency Ablation in Primary Aldosteronism

Abstract

The radiofrequency ablation (RFA) technique has been extensively used in the treatment of primary malignancies and metastases and has been recently deployed for the treatment of unilateral primary aldosteronism (PA) as an alternative to whole unilateral adrenalectomy.

Current evidence comparing RFA with unilateral adrenalectomy in the treatment of PA so far has been variable, with studies being retrospective and small-scale, but it remains a very attractive option as a potentially less invasive treatment option compared to adrenalectomy.

This review article describes the procedure, and provides evidence and the possible future direction of RFA in the treatment of unilateral PA.

Key words

Hypertension<Cardiovascular incidences - Coronary syndrome<Cardiovascular incidences - Cardiovascular risk management<Cardiovascular incidences

Publication History

Received: 24 April 2023
Received: 22 June 2023

Accepted: 05 July 2023

Accepted Manuscript online:
13 July 2023

Article published online:
11 August 2023

• References

• 1 Donlon P, Dennedy MC. Thermal ablation in adrenal disorders: A discussion of the technology, the clinical evidence and the future. Curr Opin Endocrinol Diabetes Obes 2021; 28: 291-302
• 2 Zhang H, Li Q, Liu X. et al. Adrenal artery ablation for primary aldosteronism without apparent aldosteronoma: An efficacy and safety, proof-of-principle trial. J Clin Hypertens (Greenwich) 2020; 22: 1618-1626
• 3 Zhao Z, Liu X, Zhang H. et al. Catheter-based adrenal ablation remits primary aldosteronism: A randomized medication-controlled trial. Circulation 2021; 144: 580-582
• 4 Wu X, Senanayake R, Goodchild E. et al. [(11)C]metomidate PET-CT versus adrenal vein sampling for diagnosing surgically curable primary aldosteronism: A prospective, within-patient trial. Nat Med 2023;
• 5 Costa N, Mounie M, Gombault-Datzenko E. et al. Cost analysis of radiofrequency ablation for adrenal adenoma in patients with primary aldosteronism and hypertension: Results from the ADERADHTA pilot study and comparison with surgical adrenalectomy. Cardiovasc Intervent Radiol 2022;
• 6 Rossi GP, Bernini G, Caliumi C. et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293-2300
• 7 Brown JM, Siddiqui M, Calhoun DA. et al. The unrecognized prevalence of primary aldosteronism: A cross-sectional study. Ann Intern Med 2020; 173: 10-20
• 8 Bouhanick B, Delchier MC, Lagarde S. et al. Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study. J Hypertens 2021; 39: 759-765
• 9 Williams TA, Lenders JWM, Mulatero P. et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol 2017; 5: 689-699
• 10 Chini EN, Brown MJ, Farrell MA. et al. Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. Anesth Analg 2004; 99: 1867-1869
• 11 Dhaliwal A, Kolli S, Dhindsa BS. et al. Efficacy of EUS-RFA in pancreatic tumors: Is it ready for prime time? A systematic review and meta-analysis. Endosc Int Open 2020; 8: E1243-E1251
• 12 Sarwar A, Brook OR, Vaidya A. et al. Clinical outcomes following percutaneous radiofrequency ablation of unilateral aldosterone-producing adenoma: Comparison with adrenalectomy. J Vasc Interv Radiol 2016; 27: 961-967
• 13 Yang MH, Tyan YS, Huang YH. et al. Comparison of radiofrequency ablation versus laparoscopic adrenalectomy for benign aldosterone-producing adenoma. Radiol Med 2016; 121: 811-819
• 14 Abbas A, Idriz S, Railton NJ. et al. Image-guided ablation of Conn’s adenomas in the management of primary hyperaldosteronism. Clin Radiol 2013; 68: 279-283
• 15 Liu SY, Chu CM, Kong AP. et al. Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma. Br J Surg 2016; 103: 1476-1486
• 16 Beland MD, Mayo-Smith WW. Ablation of adrenal neoplasms. Abdom Imaging 2009; 34: 588-592
• 17 Williams TA, Gomez-Sanchez CE, Rainey WE. et al. International histopathology consensus for unilateral primary aldosteronism. J Clin Endocrinol Metab 2021; 106: 42-54
• 18 Cano-Valderrama O, Gonzalez-Nieto J, Abad-Cardiel M. et al. Laparoscopic adrenalectomy vs. radiofrequency ablation for the treatment of primary aldosteronism. A single center retrospective cohort analysis adjusted with propensity score. Surg Endosc 2022; 36: 1970-1978
• 19 Szejnfeld D, Nunes TF, Giordano EE. et al. Radiofrequency ablation of functioning adrenal adenomas: Preliminary clinical and laboratory findings. J Vasc Interv Radiol 2015; 26: 1459-1464
• 20 Argentesi G, Wu X, Goodchild E. et al. Preliminary data from FABULAS: A feasibility study of RadioFrequency endoscopic ABlation, with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone producing adenomas. Endocrine Abstracts 2022; 153