Clinical Outcomes Following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone Producing Adenoma: Comparison to adrenalectomy

Abstract

Purpose

To compare the efficacy of adrenal radiofrequency ablation (RFA) in treating unilateral aldosterone producing adenomas (APA) with adrenalectomy.

Materials and Methods

Between 04/2008–09/2013, 44 patients with adrenal venous sampling confirmed (lateralization index ≥ 4) unilateral APA underwent adrenal RFA (12/44 [27%]) or adrenalectomy (32/44 [73%]). Outcomes of patients treated with adrenal RFA (51±11 years, 4/12 male) were compared to patients treated with adrenalectomy (50±11 years, 19/32 male). Pre-treatment blood pressure (145±19/94±13 vs. 144±10/89±8; p=0.92), number of anti-hypertensives (3.0 ±1.3 vs. 2.7±0.89; p=0.38) and serum potassium (3.2±0.6 vs. 3.5±0.6 mEq/L; p=0.65) of RFA and adrenalectomy patients were similar.

Results

Both RFA and adrenalectomy resulted in post-procedural normokalemia (RFA: 4.2±0.1 mEq/L; p=0.0004 vs. adrenalectomy: 4.3±0.6 mEq/L; p<0.0001) and normotension (RFA: 129±11/81±11 mmHg; p=0.02/0.001 vs. adrenalectomy: 128±13/85±12; p<0.0001/p=0.07) in all patients. Proportions of RFA and adrenalectomy patients cured of hypertension (2/12 (17%) vs. 12/32 (38%), p=0.28) or requiring fewer anti-hypertensives (7/12 (58%) vs. 13/32 (40%), p=0.29) was similar. RFA patients had a shorter length of stay (0.6±0.8d [Range: 0–2d] vs. 1.7±1.4d [0–7d], p=0.01) and lower intra-operative blood loss (1.2±3ml vs. 40±85ml, p=0.01) compared to adrenalectomy patients. Procedural complications occurred in 5/32 (15%) adrenalectomy patients (2 major, 3 minor) and in none of the RFA patients.

Conclusion

RFA to treat APA can achieve clinical outcomes that approach adrenalectomy but result in shorter hospital stays. Larger, prospective trials are needed to validate these results.