Radiofrequency ablation for benign aldosterone-producing adenoma: a scarless technique to an old disease.
OBJECTIVE
To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating primary aldosteronism (PA) due to aldosterone-producing adenoma (APA).


BACKGROUND
Radiofrequency ablation is an established technique for treating malignant solid organ neoplasm. Its application on benign functional adrenal adenoma has never been prospectively described.


METHODS
We prospectively evaluated a patient cohort with computed tomography (CT)-guided percutaneous RFA performed on functional APA of size 4 cm or less. Treatment success was defined as complete tumor ablation on follow-up CT scan plus normalization of serum aldosterone-to-renin ratio (ARR) at 3 to 6 months after RFA. Salvage laparoscopic adrenalectomy was offered to patients who had failed RFA and remained hypertensive.


RESULTS
Between August 2004 and August 2008, 28 patients were referred for the procedure. Radiofrequency ablation was not performed on 4 APA because of their close proximity to major vascular structures. Twenty-four patients (11 men and 13 women) with a median age of 51.5 (range = 34-63) years underwent RFA for 11 right and 13 left APA. The median tumor diameter was 16.0 (range = 4.0-25.0) mm. There was no periprocedure hypertensive crisis or major morbidity or mortality. Minor complications occurred in 4 patients (16.7%), including 1 small pneumothorax and 3 retroperitoneal hematomas (< 3 cm), which all resolved on conservative treatment. At 3 to 6 months of follow-up, CT scan showed complete tumor ablation in all patients (100%). Primary aldosteronism was biochemically resolved in 23 patients (95.8%). Salvage adrenalectomy was not performed in the single failed patient, as she remained normotensive on repeated follow-up. The overall success rate of RFA was 95.8%.


CONCLUSIONS
Computed tomography-guided percutaneous RFA is a safe and efficacious alternative to laparoscopic adrenalectomy in treating patients with PA due to small APA.
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
Shirley Yuk-Wah
SY
Liu
Enders Kwok-Wai
EK
Ng
Paul Sing-Fun
PS
Lee
Simon Kin-Hung
SK
Wong
Philip Wai-Yan
PW
Chiu
Wilfred Lik-Man
WL
Mui
Wing-Yee
WY
So
Francis Chun-Chung
FC
Chow
D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000601:surgery*; D000328:Adult; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome