ablation of aldosteronomas

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Published online before print April 3, 2003, 10.1148/radiol.2272011798

(Radiology 2003;227:401-406.)

C RSNA <http://radiology.rsnajnls.org/misc/terms.shtml> , 2003

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Vascular and Interventional Radiology

Aldosteronomas: Experience with Superselective Adrenal Arterial Embolization in

33 Cases1

Hirofumi Hokotate, MD, Hiroki Inoue, MD, PhD, Yasutaka Baba, MD, Shinsaku

Tsuchimochi, MD, PhD and Masayuki Nakajo, MD, PhD

1 From the Department of Radiology, Faculty of Medicine, Kagoshima University,

8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. From

the 2000 RSNA scientific assembly. Received November 7, 2001; revision requested

January 21, 2002; final revision received July 26;

accepted August 19. Address correspondence to H.H. (e-mail:

hirofumi@...).

PURPOSE: To evaluate the effectiveness and long-term follow-up results of

superselective adrenal arterial embolization (SAAE) of

aldosteronomas.

MATERIALS AND METHODS: Thirty-three patients with unilateral aldosteronomas were

treated with SAAE. A 0.2-7.0-mL dose of

high-concentration ethanol (HCE) was selectively infused into the feeding

arterial branches of the aldosteronoma through a

microcatheter by using a coaxial technique. Hormone, electrolyte, and blood

pressure levels were evaluated after SAAE. The influence

of background factors on SAAE success rate and the influence of age on

hypertension in the patients in whom SAAE was successful were

assessed with the Fisher exact test and a logistic regression model.

RESULTS: SAAE was successful in 27 (82%) of 33 patients. SAAE success rate was

not influenced by sex, age, hypertension duration,

family history of hypertension, adenoma site, type of ethanol used, or number of

embolized arteries. The destructive effects of SAAE

continued for the 6-94-month (mean, 45 months) follow-up period in all patients

in whom SAAE was successful. In one patient,

aldosteronoma recurred 15 months after SAAE and the second SAAE was successful.

Blood pressure decreased in all 11 (100%) patients

aged 45 years or younger and in eight (50%) of 16 patients older than 45 years

(P = .008). Blood pressure decreased within 4 weeks

after SAAE in 15 (79%) of these 19 patients. The rate of blood pressure

reduction after SAAE decreased with increasing age, and the

correlation was significant (P = .022). None of the 33 patients had severe

complications.

CONCLUSION: SAAE with HCE is an effective therapy for aldosteronoma.

http://radiology.rsnajnls.org/cgi/content/abstract/227/2/401

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Published online before print February 27, 2004, 10.1148/radiol.2311031007

(Radiology 2004;231:225-230.)

C RSNA, 2004

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Vascular and Interventional Radiology

Adrenal Neoplasms: CT-guided Radiofrequency Ablation-Preliminary Results1

W. Mayo-, MD and Damian E. Dupuy, MD

1 From the Department of Radiology, Rhode Island Hospital, Brown Medical School,

593 Eddy St, Providence, RI 02903. From the 2002

RSNA scientific assembly. Received June 27, 2003; revision requested August 26;

revision received September 11; accepted October 20.

Address correspondence to W.W.M.S. (e-mail: wmayo-smith@...).

PURPOSE: To evaluate initial experience with radiofrequency (RF) ablation of

adrenal neoplasms.

MATERIALS AND METHODS: Thirteen adrenal masses in 12 patients (bilateral

metastases in one patient) were treated with computed

tomography (CT)-guided percutaneous RF ablation. Eleven adrenal lesions were

metastases (five from lung cancer, four from renal cell

carcinoma, and two from melanoma); one lesion was a pheochromocytoma and one was

an aldosteronoma. There were 10 men and two women

(average age, 58 years; range, 40-77 years) in the study; average adrenal mass

diameter was 3.9 cm (range, 1-8 cm). Average number

of RF applications per adrenal mass was 2.7 (range, 1-5 applications); average

time per application was 7.8 minutes (range, 4-13

minutes). An internally cooled single electrode was used in five sessions; an

internally cooled cluster electrode was used in eight

sessions.

RESULTS: Average follow-up was 11.2 months (range, 1-46 months). Eleven of 13

lesions were treated successfully with RF ablation

after one session. Successful treatment was defined as lack of enhancement of

the treated region on follow-up CT images and

resolution of the biochemical abnormality in two patients. In two patients with

large adrenal lesions (4 and 8 cm in diameter),

enhancement of residual tissue was observed after one treatment session; this

finding was indicative of residual tumor. One patient

with thrombocytopenia that resulted from chemotherapy had a small hematoma, but

no transfusion was required. No patient developed

hypertension during the RF application. No patient with metastases had recurrent

tumor at the treated site, and this lack of

recurrence indicated effective local control; 11 patients had progression of

metastatic disease at extraadrenal sites.

CONCLUSION: Preliminary data suggest that CT-guided RF ablation is an effective

technique for local control of adrenal neoplasms.

http://radiology.rsnajnls.org/cgi/content/abstract/231/1/225

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American Journal of Roentgenology, Vol 168, 1241-1245, Copyright C 1997 by

American Roentgen Ray Society

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Transcatheter arterial ablation of aldosteronomas with high- concentration

ethanol: preliminary and long-term results

H Inoue, M Nakajo, N Miyazono, H Nishida, K Ueno and H Hokotate

Department of Radiology, Faculty of Medicine, Kagoshima University, Japan.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of

transcatheter arterial ablation (TAA) of aldosteronomas with

high- concentration ethanol (HCE). MATERIALS AND METHODS: From August 1992 to

August 1995, 18 patients with unilateral

aldosteronoma, three men and 15 women, 28-65 years old, were treated by TAA with

HCE. A single dose (0.2-7.0 ml) of HCE was

selectively infused into the feeding arterial branches of the aldosteronoma

using a microcatheter and the coaxial technique. The 18

patients underwent 31 TAA procedures. RESULTS: Ablation of the aldosteronoma was

monitored by measuring plasma levels of aldosterone

and was successful in 15 (83%) of 18 patients. The remaining three patients

underwent surgery because results of TAA were

insufficient. The destructive effect of ablation by HCE has persisted for 7-38

months (mean, 20 months) in 14 patients. Although one

patient had recurrence of symptoms 15 months after the initial TAA,

normalization of plasma levels of aldosterone continued for 3

months after TAA was repeated. No severe complications occurred in any of the 18

patients. However, back pain (18 of 18), slight

fever (nine of 18), pleural effusion (two of 18), and labile changes in blood

pressure (one of 18) were noted in patients 1-7 days

after the procedure. CONCLUSION: TAA of aldosteronoma with HCE is an alternative

to open adrenalectomy.

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