Ultrasound-guided radiofrequency ablation may be effective for treatment of aldosterone-producing adenomas

1. There were no gastric and adrenal puncture instances among patients who underwent radio-ablation in both groups.

2. Majority of patients achieved either complete or partial biochemical cure post-ablation.

Evidence Rating Level: 2 (Good)

Study Rundown: Diagnostic and therapeutic measures for the management of aldosterone-producing adrenal adenomas (APAs) are often invasive. Ultrasound-guided trans-gastric radiofrequency ablation (EUS-RFA) offers a minimally invasive alternative for treating unilateral APAs. This prospective trial aimed to evaluate the safety and effectiveness of EUS-RFA in selectively ablating APAs without damaging surrounding tissues. The primary outcome of this study was the safety of EUS-RFA, assessed by the absence of major complications such as perforation, hemorrhage, or infarction, while a key secondary outcome was reduction in radiotracer uptake. According to study results, EUS-RFA successfully ablated APAs without major complications and led to complete or partial biochemical cure in most patients. Although this study was well done, it was limited by a small sample size and lack of direct comparison to adrenalectomy, necessitating further research.

Click to read the study in The Lancet

Relevant Reading: Aldosterone-Producing Adenomas of Increased Size Are Associated With Higher Steroidogenic Activity

In-depth [prospective cohort]: Between Feb 21, 2018, and Feb 10, 2023, 44 patients were screened across 3 centers in the UK. Included were patients aged ≥ 18 years with primary aldosteronism and a left-sided APA, confirmed by adrenal vein sampling (AVS) or PET-CT. Altogether, 28 patients (21 in a single ablation procedure, 7 in two ablation procedures) were included in the final analysis. Mean patient age was 57.7 years (standard deviation [SD] 10.3) with the majority (75%) being male. There was no major complication reported in either groups. Furthermore, the secondary outcome of efficacy showed that 75% (95% confidence interval [CI] 55-91) of patients achieved either complete or partial biochemical cure, while 43% (95% CI 24-61) experienced complete or partial resolution of hypertension. Findings from this study suggest that EUS-RFA is a promising, minimally invasive alternative to adrenalectomy for unilateral APAs.

Image: PD

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