title: Aldosterone-producing Adenoma in Primary Aldosteronism: CT-guided Radiofrequency Ablation-Long-term Results and Recurrence Rate.
abstract: Purpose To evaluate the long-term biochemical, clinical, and recurrence outcomes of radiofrequency (RF) ablation in treating primary aldosteronism due to aldosterone-producing adenoma (APA). Materials and Methods Institutional review board approval and written informed consent were obtained. The use of computed tomographically (CT) guided percutaneous RF ablation was evaluated in 36 patients (19 men; mean age ± standard deviation, 52.1 years ± 10.4) with APA (17 right and 19 left side; mean size, 15.5 mm ± 5.0). Primary aldosteronism was confirmed by using the oral sodium-loading test. After RF ablation, CT images, aldosterone-to-renin ratio (ARR), serum potassium level, and blood pressure control were assessed at 3 months and at the latest follow-up examination. Long-term treatment success was defined as normalization of ARR at the latest assessment. Comparison of ARR, potassium, and blood pressure levels before and after RF ablation was performed by using the Wilcoxon signed-rank test. Results Primary technical success was achieved in 33 (92%) patients who underwent a single RF ablation session. Secondary technical success was achieved in three (8%) patients who required a second RF ablation. At 3-month follow-up, primary aldosteronism was resolved in 33 (92%) patients, with a starting median ARR of 8583 pmol/L per µg/(L · h) that normalized to 97 pmol/L per µg/(L · h) (P < .01). Mean serum potassium levels increased from 2.6 mmol/L ± 0.4 to 4.0 mmol/L ± 0.3 (P = .01). At long-term follow-up (mean, 6.2 years ± 2.5), treatment success was maintained in 33 patients (92%), all of whom had ARRs in the normal range (P < .01). The long-term recurrence rate was 0%. Hypokalemia was resolved in all patients (2.6 mmol/L ± 0.4 to 4.1 mmol/L ± 0.3, P = .01). Hypertension was resolved in 13 (36%) patients, and its control was improved in seven (19%) patients. One (3%) patient had major complications and six (17%) had minor complications. Conclusion CT-guided RF ablation is an effective treatment for APA, with high sustainable long-term treatment success. It may serve as a justifiable treatment alternative to surgery and medical therapy for APA.©RSNA, 2016.
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Shirley Yuk Wah
authors.initials: SY
authors.lastname: Liu
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Charmant Cheuk Man
authors.initials: CC
authors.lastname: Chu
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Teresa Kam Chi
authors.initials: TK
authors.lastname: Tsui
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Simon Kin Hung
authors.initials: SK
authors.lastname: Wong
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Alice Pik Shan
authors.initials: AP
authors.lastname: Kong
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Philip Wai Yan
authors.initials: PW
authors.lastname: Chiu
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Francis Chun Chung
authors.initials: FC
authors.lastname: Chow
authors.affiliation: From the Departments of Surgery (S.Y.W.L., S.K.H.W., P.W.Y.C., E.K.W.N.), Diagnostic Radiology and Organ Imaging (C.C.M.C.), Chemical Pathology (T.K.C.T.), and Medicine and Therapeutics (A.P.S.K., F.C.C.C.), Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, SAR.
authors.forename: Enders Kwok Wai
authors.initials: EK
authors.lastname: Ng
mesh_terms: D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000450:Aldosterone / Q000096:biosynthesis; D014408:Biomarkers, Tumor / Q000097:blood; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011188:Potassium / Q000097:blood; D011846:Radio Waves; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D000450:Aldosterone; D011188:Potassium