What is the role of imaging-guided ablation of the adrenal glands in the treatment of hyperaldosteronism?

Updated: Oct 19, 2018
  • Author: George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London); Chief Editor: Robert P Hoffman, MD  more...
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Answer

Imaging-guided ablation of the adrenal glands (radiofrequency or chemical ablation using ethanol or acetic acid) is an alternative minimally invasive therapy for aldosteronomas and other functioning adrenal tumors. Retrospective studies, while limited in size and length of follow-up, suggest that in patients with unilateral hyperfunctioning adrenal nodules (primarily, aldosterone-producing adenomas), radiofrequency ablation delivers outcomes comparable to those of laparoscopic adrenalectomy, with reduced morbidity and speedier recovery. [50]

The indications for imaging-guided ablation as opposed to surgical management include lack of fitness for surgery owing to multiple comorbid medical conditions, unresectable tumors, tumors that have already been treated with multiple debulking procedures and patient refusal of surgery. [51] A limited number of cases of isolated adenomectomy with preservation of the remaining normal adrenal tissue have been reported. However, subtotal adrenalectomy may not be appropriate in patients with primary hyperaldosteronism because unilateral adrenal hyperplasia accounts for 14-17% of all cases of unilateral PA, whereas the prevalence of cortical adenoma within cortical hyperplasia is estimated to be 6-24%. [4]

A limited number of cases of isolated adenomectomy with preservation of the remaining normal adrenal tissue have been reported. Transcatheter arterial ablation with high-concentration ethanol injection of APA has been reported.


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