PP.25.02] A NOVEL TREATMENT FOR BILATERAL HYPERPLASIA AS A CAUSE OF PRIMARY ALDOSTERONISM

Abstract

Objective: Laparoscopic surgery is the preferred treatment in patients with primary aldosteronism and unilateral disease. In bilateral cases, medical treatment is the choice–spironolactone or eplerenone- but optimal control is not globally accomplished. CT-guided radiofrequency ablation was developed in our centre in order to decrease aldosterone secretion, among patients with bilateral disease, treating the gland with the highest secretion. Our aim was to test a novel therapeutic approach among this patients. Design and method: Renin/aldosterone ratio, high resolution CT, adrenal selective venography and plasmatic aldosterone and cortisol was performed in the whole sample. Evolution of blood pressure (BP) levels and medical treatment modification was followed-up. Results: 16 patients were included (aged 29–79), 56,3 % male, time of diagnosis 1–30 years. More than 50% had concentric left ventricular hypertrophy as more frequent target organ damage. The severity of hypertension under specific treatment was: 2 patients grade 3, 7 grade 2 and 7 grade 1. After the ablation, the results were: 2 patients grade 2, 2 grade 1 and the remainder 12 controlled their BP. One year later, 3 patients had controlled BP level without treatment, 7 patients had controlled BP and decreased their antihypertensive pills, 3 patients had controlled BP without decreasing treatment and 2 patients went up uncontrolled. Only 1 case had pain in the right hyppochondrius, resolved with analgesia in 24 hours. Conclusions: Radiofrequency ablation is a useful technique to improve BP control in primary aldosteronism due to adrenal bilateral disease. Ablation of overactive adrenal glands by experts is an effective technique without major complications.