CLINICAL AND BIOCHEMICAL OUTCOMES AFTER RADIOFREQUENCY ABLATION FOR ALDOSTERONE-PRODUCING ADENOMA AT KEIO UNIVERSITY HOSPITAL - 2020 ANNUAL REPORT

Abstract

Objective: Total adrenalectomy of affected adrenal is the standard therapy for aldosterone-producing adenoma (APA), which is a curable subtype of primary aldosteronism (PA). However, there are cases in which total adrenalectomy could not be performed because of bilateral adenomas or incapability of operation under general anesthesia. For these cases radiofrequency ablation (RFA), which is minimally invasive and enables cortical-sparing treatment, could be a choice of treatment. A multicenter clinical trial of RFA for APA was performed in Japan from 2015 to 2016. The long-term efficacy of this treatment remains to be established, so we have assessed its effectiveness and safety annually and reported it at ISH 2018. The evaluation of clinical and biochemical outcomes has been extended. This time we report these outcomes 4 years after treatment. Design and method: The long-term efficacy of RFA for APA was monitored and analyzed. Results: 10 cases of APA were treated with RFA between June 2015 and March 2016. 7 cases were in valid follow-up at the end of November 2019. Aldosterone-renin ratio (ARR) returned to normal in all 7 cases. Hypertension was not cured in 2 cases (29%) though ARR were normal. Urinary albumin levels were improved in all cases. Follow-up CT images showed that the tumor vanished in 1 case (14%), shrank in 3 cases (43%) and unchanged in 3 cases (43%). There were no cases indicating adrenal insufficiency after RFA. Conclusions: In average 4-year follow-up after RFA, there were no cases suggesting recurrence. RFA for APA appears to be effective and safe.