title: Catecholamine Surge during Image-Guided Ablation of Adrenal Gland Metastases: Predictors, Consequences, and Recommendations for Management.
abstract: OBJECTIVE
  To identify retrospectively predictors of catecholamine surge during image-guided ablation of metastases to the adrenal gland.
  
  
  METHODS
  Between 2001 and 2014, 57 patients (39 men, 18 women; mean age, 65 y ± 10; age range, 41-81 y) at two academic medical centers underwent ablation of 64 metastatic adrenal tumors from renal cell carcinoma (n = 27), lung cancer (n = 23), melanoma (n = 4), colorectal cancer (n = 3), and other tumors (n = 7). Tumors measured 0.7-11.3 cm (mean, 4 cm ± 2.5). Modalities included cryoablation (n = 38), radiofrequency (RF) ablation (n = 20), RF ablation with injection of dehydrated ethanol (n = 10), and microwave ablation (n = 4). Fisher exact test, univariate, and multivariate logistical regression analysis was used to evaluate factors predicting hypertensive crisis (HC).
  
  
  RESULTS
  HC occurred in 31 sessions (43%). Ventricular tachycardia (n = 1), atrial fibrillation (n = 2), and troponin leak (n = 4) developed during HC episodes. HC was significantly associated with maximum tumor diameter ≤ 4.5 cm (odds ratio [OR], 26.36; 95% confidence interval [CI], 5.26-131.99; P < .0001) and visualization of normal adrenal tissue on CT or MR imaging before the procedure (OR, 8.38; 95% CI, 2.67-25.33; P < .0001). No HC occurred during ablation of metastases in previously irradiated or ablated adrenal glands.
  
  
  CONCLUSIONS
  Patients at high risk of catecholamine surge during ablation of non-hormonally active adrenal metastases can be identified by the presence of normal adrenal tissue and tumor diameter ≤ 4.5 cm on pre-procedure CT or MR imaging.
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111. Electronic address: ffintelmann@partners.org.
authors.forename: Florian J
authors.initials: FJ
authors.lastname: Fintelmann
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Kemal
authors.initials: K
authors.lastname: Tuncali
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111.
authors.forename: Stefan
authors.initials: S
authors.lastname: Puchner
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Gervais
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Thabet
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Shyn
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Arellano
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Servet
authors.initials: S
authors.lastname: Tatli
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mueller
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Silverman
authors.affiliation: Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02111.
authors.forename: Raul N
authors.initials: RN
authors.lastname: Uppot
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002395:Catecholamines / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D002395:Catecholamines