Ps-bpr01-6: a case series of unilateral primary aldosteronism treated by radiofrequency ablation

Background: In primary aldosteronism (PA), early and appropriate management based on its subtype is crucial to abolish an enhanced cardiovascular risk. Mineralocorticoid receptor antagonists (MRAs) are the mainstay of PA treatment, while a unilateral adrenalectomy (ADX) has been considered as the gold standard intervention for unilateral PA, mainly caused by an aldosterone-producing adenoma. The laparoscopic ADX is a less-invasive procedure than open surgery, whereas the procedure harbors a perioperative risk associated with general anesthesia. Herein, we report 3 PA cases where we employed radiofrequency ablation (RFA) as an alternate therapy for their aldosterone-producing tumors. In those cases, RFA successfully and safely led to remission of PA with more reduced physical burden, compared with the laparoscopic ADX. Case presentation: We performed RFA in 3 unilateral PA cases with aldosterone-producing tumors; Case 1, a 46-year-old man with a right adrenal tumor (14 mm); Case 2, a 65-year-old man with a right adrenal tumor (15 mm); Case 3, a 47-year-old man with a left adrenal tumor (19 mm). At baseline, their blood pressure levels were 124/87, 118/79 and 142/88 mmHg under 1, 2 and 2 antihypertensive agents, respectively. Plasma aldosterone concentrations and renin activity levels were as follows; 29.70, 25.7 and 48.6 ng/dL and 0.5, < 0.2 and < 0.2 ng/mL/hr, respectively. In all cases, we confirmed the presence and localization of PA with confirmatory tests and segmental adrenal venous sampling. Before the RFA procedure, we initiated and titrated MRAs to sufficiently block effects of hyperaldosteronism. Percutaneous RFA was guided by computed tomography under intravenous anesthesia without intubation. Complete tumor ablation was achieved within 1 hour, confirmed by enhanced adrenal imaging. No major complication was observed, and physical activity was almost recovered on the same day. Three months after RFA, all 3 patients showed normotension without any antihypertensives. For biochemical parameters, plasma aldosterone levels decreased to 2.47, < 0.40 and 1.41 ng/dL in Case 1, 2 and 3, respectively, followed by mild restoration of plasma renin activity (1.4, 0.5 and < 0.2 ng/mL/hr, respectively). Conclusion: This case series demonstrates that RFA is an alternate treatment for unilateral PA. Based on accurate localization of hyperaldosteronism, RFA could cause necrosis of only an adrenal-producing tumor and spare an ipsilateral adjacent adrenal gland, resulting in remission of PA with minimal physical burden.