Radiofrequency ablation for adenoma in patients with primary aldosteronism and hypertension: ADERADHTA, a pilot study

Béatrice Bouhanick, Marie C Delchier, Séverine Lagarde, Romain Boulestreau, Claude Conil, Philippe Gosse, Hervé Rousseau, Benoit Lepage, Pascale Olivier, Panteleimon Papadopoulos, Hervé Trillaud, Antoine Cremer, ADERADHTA group, Béatrice Bouhanick, Marie C Delchier, Séverine Lagarde, Romain Boulestreau, Claude Conil, Philippe Gosse, Hervé Rousseau, Benoit Lepage, Pascale Olivier, Panteleimon Papadopoulos, Hervé Trillaud, Antoine Cremer, ADERADHTA group

Abstract

Objective: To evaluate the efficacy and the feasibility of radiofrequency ablation to treat aldosterone-producing adenomas.

Methods: In an open prospective bicentric pilot study, patients with hypertension on ambulatory blood pressure measurement, a primary aldosteronism, an adenoma measuring less than 4 cm, and confirmation of lateralization by adrenal venous sampling were recruited. The primary endpoint, based on ABPM performed at 6 months after the radiofrequency ablation, was a daytime SBP/DBP less than 135/85 mmHg without any antihypertensive drugs or a reduction of at least 20 mmHg for SBP or 10 mmHg for DBP.

Results: Thirty patients have been included (mean age = 51 ± 11 years; 50% women). Mean baseline daytime SBP and DBP were 144 ± 19 / 95 ± 15 mmHg and 80% received at least two antihypertensive drugs. At 6 months: 47% (95% CI 28-66) of patients reached the primary endpoint, mean daytime SBP and DBP were 131 ± 14 (101-154)/87 ± 10 (71-107) mmHg; 43% of them did not take any antihypertensive drug and 70% of them did not take potassium supplements. Few complications were recorded: four cases of back pain at day 1 postablation; three limited pneumothoraxes, which resolved spontaneously; one lesion of a polar renal artery.

Conclusion: Radiofrequency ablation for hypertensive patients with aldosterone-producing adenomas seems to be an emerging promising alternative to surgery. Its efficacy and its feasibility have to be confirmed in a larger sample of patients.

Conflict of interest statement

There are no conflicts of interest.

Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.

References

    1. Conn JW. Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med 1955; 45:3–17.
    1. Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al. . Primary Aldosteronism Surgery Outcome (PASO) investigators. 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.
    1. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF, Jr, et al. . Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008; 93:3266–3281.
    1. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, Stowasser M, et al. . The management of primary aldosteronism: case detection, diagnosis, and treatment: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2016; 101:1889–1916.
    1. Steichen O, Amar L, Chaffanjon P, Kraimps JL, Ménégaux F, Zinzindohoue F. SFE/SFHTA/AFCE consensus on primary aldosteronism, part 6: adrenal surgery. Ann Endocrinol (Paris) 2016; 77:220–225.
    1. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg 2004; 91:1259–1274.
    1. Pędziwiatr M, Wierdak M, Ostachowski M, Natkaniec M, Białas M, Hubalewska-Dydejczyk A, et al. . Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy-lessons learned after 500 cases: a retrospective cohort study. Int J Surg 2015; 20:88–94.
    1. Nomine-Criqui C, Brunaud L, Germain A, Klein M, Cuny T, Ayav A, Bresler L. Robotic lateral transabdominal adrenalectomy. J Surg Oncol 2015; 112:305–309.
    1. Gazelle GS, Goldberg SN, Solbiati L, Livraghi T. Tumor ablation with radio-frequency energy. Radiology 2000; 217:633–646.
    1. Rathke H, Hamm B, Güttler F, Rathke J, Rump J, Teichgräber U, de Bucourt M. Comparison of four radiofrequency ablation systems at two target volumes in an ex vivo bovine liver model. Diagn Interv Radiol 2014; 20:251–258.
    1. Wood BJ, Abraham J, Hvizda JL, Alexander HR, Fojo T. Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases. Cancer 2003; 97:554–560.
    1. Mayo-Smith WW, Dupuy DE. Adrenal neoplasms: CT-guided radiofrequency ablation–preliminary results. Radiology 2004; 231:225–230.
    1. Keeling AN, Sabharwal T, Allen MJ, Hegarty NJ, Adam A. Hypertensive crisis during radiofrequency ablation of the adrenal gland. J Vasc Interv Radiol 2009; 20:990–991.
    1. Berber E, Siperstein A. Laparoscopic radiofrequency thermal ablation of adrenal tumors: technical details. Surg Laparosc Endosc Percutan Tech 2010; 20:58–62.
    1. Venkatesan AM, Locklin J, Dupuy DE, Wood BJ. Percutaneous ablation of adrenal tumors. Tech Vasc Interv Radiol 2010; 13:89–99.
    1. Al-Shaikh AA, Al-Rawas MM, Al-Asnag MA. Primary hyperaldosteronism treated by radiofrequency ablation. Saudi Med J 2004; 25:1711–1714.
    1. Johnson SP, Bagrosky BM, Mitchell EL, McIntyre RC, Jr, Grant NG. CT-guided radiofrequency ablation of an aldosterone-secreting primary adrenal tumor in a surgically unfit patient. J Vasc Interv Radiol 2008; 19:1115–1117.
    1. Liu SY, Ng EK, Lee PS, Wong SK, Chiu PW, Mui WL, et al. . Radiofrequency ablation for benign aldosterone-producing adenoma: a scarless technique to an old disease. Ann Surg 2010; 252:1058–1064.
    1. Nunes TF, Szejnfeld D, Szejnfeld J, Kater CE, Faintuch S, Castro CHM, Goldman SM. Assessment of early treatment response with DWI after CT-guided radiofrequency ablation of functioning adrenal adenomas. AJR Am J Roentgenol 2016; 207:804–810.
    1. Liu SY, Chu CC, Tsui TK, Wong SK, Kong AP, Chiu PW, et al. . Aldosterone-producing adenoma in primary aldosteronism: CT-guided radiofrequency ablation-long-term results and recurrence rate. Radiology 2016; 281:625–634.
    1. Yang R, Xu L, Lian H, Gan W, Guo H. Retroperitoneoscopic-guided cool-tip radiofrequency ablation of adrenocortical aldosteronoma. J Endourol 2014; 28:1208–1214.
    1. Szejnfeld D, Nunes TF, Giordano EE, Freire F, Ajzen SA, Kater CE, Goldman SM. Radiofrequency ablation of functioning adrenal adenomas: preliminary clinical and laboratory findings. J Vasc Interv Radiol 2015; 26:1459–1464.
    1. Yang MH, Tyan YS, Huang YH, Wang SC, Chen SL. Comparison of radiofrequency ablation versus laparoscopic adrenalectomy for benign aldosterone-producing adenoma. Radiol Med 2016; 121:811–819.
    1. Sarwar A, Brook OR, Vaidya A, Sacks AC, Sacks BA, Goldberg SN, et al. . Clinical outcomes following percutaneous radiofrequency ablation of unilateral aldosterone-producing adenoma: comparison with adrenalectomy. J Vasc Interv Radiol 2016; 27:961–967.
    1. Lo CH, Tyan YS, Ueng KC. Immediate results and long-term outcomes following percutaneous radiofrequency ablation of unilateral aldosterone-producing adenoma. Acta Cardiol Sin 2020; 36:160–167.
    1. Douillard C, Houillier P, Nussberger J, Girerd X. SFE/SFHTA/AFCE Consensus on Primary Aldosteronism, part 2: first diagnostic steps. Ann Endocrinol (Paris) 2016; 77:192–201.
    1. Bardet S, Chamontin B, Douillard C, Pagny JY, Hernigou A, Joffre F, et al. . SFE/SFHTA/AFCE consensus on primary aldosteronism, part 4: Subtype diagnosis. Ann Endocrinol (Paris) 2016; 77:208–213.
    1. Mulatero P, Sechi LA, Williams TA, Lenders JWM, Reincke M, Satoh F, Januszewicz A, et al. . Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension. J Hypertens 2020; 38:1929–1936.
    1. Arima K, Yamakado K, Suzuki R, Matsuura H, Nakatsuka A, Takeda K, Sugimura Y. Image-guided radiofrequency ablation for adrenocortical adenoma with Cushing syndrome: outcomes after mean follow-up of 33 months. Urology 2007; 70:407–411.
    1. Rhim H, Goldberg SN, Dodd GD, 3rd, Solbiati L, Lim HK, Tonolini M, Cho OK. Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. Radiographics 2001; 21:S17–S35.
    1. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. . 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31:1281–1357.
    1. Liu SY, Chu CM, Kong AP, Wong SK, Chiu PW, Chow FC, Ng EK. Radiofrequency ablation compared with laparoscopic adrenalectomy for aldosterone-producing adenoma. Br J Surg 2016; 103:1476–1486.
    1. Brook OR, Mendiratta-Lala M, Brennan D, Siewert B, Faintuch S, Goldberg SN. Imaging findings after radiofrequency ablation of adrenal tumors. AJR Am J Roentgenol 2011; 196:382–388.
    1. Sacks BA, Sacks AC, Faintuch S. Radiofrequency ablation treatment for aldosterone-producing adenomas. Curr Opin Endocrinol Diabetes Obes 2017; 24:169–173.
    1. Bouhanick B, Amar J, Amar L, Gosse P, Girerd X, Reznik Y. investigators of the ASAPAS study. Arterial stiffness evaluated by pulse wave velocity is not predictive of the improvement in hypertension after adrenal surgery for primary aldosteronism: a multicentre study from the French European Society of Hypertension Excellence Centres. Arch Cardiovasc Dis 2018; 111:564–572.
    1. Steichen O, Zinzindohoué F, Plouin PF, Amar L. Outcomes of adrenalectomy in patients with unilateral primary aldosteronism: a review. Horm Metab Res 2012; 44:221–227.
    1. Nunes TF, Szejnfeld D, Xavier AC, Kater CE, Freire F, Ribeiro CA, Goldman SM. Percutaneous ablation of functioning adrenal adenoma: a report on 11 cases and review of the literature. Abdom Imaging 2013; 38:1130–1135.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera