Endocrine Abstracts

Introduction: Unilateral aldosterone-producing adenoma (APAs) represents a potentially curable cause of hyper - tension through laparoscopic adrenalectomy. However, surgical intervention may not be suitable for all patients, particularly those with significant comorbidities or a preference for less invasive management. Endoscopic ultrasound (US)-guided trans-gastric (TG) radiofrequency ablation (RFA) offers a minimally invasive alternative to treat left-sided APAs which are in close proximity with the stomach. This new approach was successfully performed in our center.

Case report: A 35-year-old woman with a history of familial adenomatous polyposis syndrome and previous total colectomy was referred for assessment of hypertension associated with severe hypokalemia at 2.14 mmol/l. Biochemical evaluation confirmed primary aldosteronism with high plasma aldosterone (47.1ng/dl; nl<14), suppressed renin concentration (0.8 mU/l; nl>4.0) and a high aldosterone-to-renin ratio of 58.9 (nl<2.4). Abdominal CT-scan imaging showed bilateral adrenal nodules (left: 23 x 16 mm and right: 17 x 12 mm), both evoking benign adenomas. Adrenal vein sampling showed a clear lateralization ratio (10.0) of aldosterone secretion from the left side. As the patient expressed a clear desire for a minimally invasive curative treatment with preservation of left adrenal tissue, endoscopic US-TG-RFA was considered after informed consent. After a medical preparation with spironolactone 50 mg/day and an alpha-blocker (terazosin 2.5 mg twice daily for 2 weeks), the left adrenal nodule could be successfully ablated under light general anesthesia, using a 10 mm STARMed needle (Taewoong Medical, Seoul, South Korea) and generator set at 30 W.

Follow-up: No immediate complication was noted after the procedure and blood pressure and heart rate remained normal. Complete clinical remission of hypertension was achieved within one week, allowing discontinuation of spironolactone. After one month, the patient’s blood pressure remained consistently below 104/84 mmHg without medication, and CT scan imaging showed a stable size of the left adrenal lesion with focal areas of necrosis but no evidence of delayed complication. Biochemical cure of PA was confirmed by normalization of kalemia (4.68 mmol/l), aldosterone (9.7 ng/dl) and renin concentrations (4.1 mU/l).

Conclusion: Endoscopic ultrasound-guided trans-gastric RFA is an effective and safe, minimally invasive, adrenalsparing alternative to surgery for patients with unilateral left-sided APA.

Reference: 1. Argentesi G, Wu X, Ney A, Goodchild E, Laycock K, Lee Y N, et al. Endoscopic, ultrasound-guided, radiofrequency ablation of aldosterone producing adenomas (FABULAS): a UK, multicentre, prospective, proof of concept trial. Lancet. 2025 Feb 8;405(10479):637-647. doi:10.1016/S0140-6736(24)02755 7

Keywords: Radiofrequency ablation, left-sided aldosterone producing adenoma, primary hyperaldosteronism