title: Clinical Outcomes following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma: Comparison with Adrenalectomy.
abstract: OBJECTIVE
  To compare adrenal radiofrequency (RF) ablation with adrenalectomy in treating unilateral aldosterone-producing adenoma (APA).
  
  
  METHODS
  Between April 2008 and September 2013, 44 patients with adrenal venous sampling-confirmed (lateralization index ≥ 4) unilateral APA underwent adrenal RF ablation (12/44 [27%]) or adrenalectomy (32/44 [73%]). Outcomes of adrenal RF ablation (patient age, 51 y ± 11; 4/12 men) were compared with adrenalectomy (patient age, 50 y ± 11; 19/32 men). Blood pressure (145/94 mm Hg ± 19/13 vs 144/89 mm Hg ± 10/8, P = .92), number of antihypertensives (3.0 ± 1.3 vs 2.7 ± 0.89, P = .38), and serum potassium (3.2 mEq/L ± 0.6 vs 3.5 mEq/L ± 0.6, P = .65) of patients were similar before treatment.
  
  
  RESULTS
  RF ablation and adrenalectomy resulted in normokalemia (RF ablation, 4.2 mEq/L ± 0.1, P = .0004; adrenalectomy, 4.3 mEq/L ± 0.6, P < .0001) and normotension (RF ablation, 129/81 mm Hg ± 11/11, P = .02/P = .001; adrenalectomy, 128/85 mm Hg ± 13/12, P < .0001/P = .07) in all patients. Proportions of RF ablation and adrenalectomy patients cured of hypertension (2/12 [17%] vs 12/32 [38%], P = .28) or requiring fewer antihypertensives (7/12 [58%] vs 13/32 [40%], P = .29) were similar. RF ablation patients had a shorter length of stay (0.6 d ± 0.8 [range, 0-2 d] vs 1.7 d ± 1.4 [range, 0-7 d]; P = .01) and less intraoperative blood loss (1.2 mL ± 3 vs 40 mL ±85; P = .01). Procedural complications occurred in 5/32 (15%) adrenalectomy patients (2 major, 3 minor) and in 0/12 RF ablation patients.
  
  
  CONCLUSIONS
  RF ablation to treat APA can achieve similar clinical outcomes as adrenalectomy and results in shorter hospital stays. Larger, prospective trials are needed to validate these results.
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215. Electronic address: asarwar@bidmc.harvard.edu.
authors.forename: Ammar
authors.initials: A
authors.lastname: Sarwar
authors.affiliation: Department of Medicine Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Olga R
authors.initials: OR
authors.lastname: Brook
authors.affiliation: Department of Medicine Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Anand
authors.initials: A
authors.lastname: Vaidya
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ari C
authors.initials: AC
authors.lastname: Sacks
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Sacks
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: S Nahum
authors.initials: SN
authors.lastname: Goldberg
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Muneeb
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, WCC 308-B, 1 Deaconess Road, Boston, MA 02215.
authors.forename: Salomao
authors.initials: S
authors.lastname: Faintuch
mesh_terms: D000236:Adenoma / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects; D000328:Adult; D000450:Aldosterone / Q000097:blood*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D001900:Boston; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D014408:Biomarkers, Tumor; D000450:Aldosterone