Endocrine Abstracts

A 44-year-old female with a history of left hepatectomy for a hydatid cyst was referred following an incidental finding of a 2.8 cm right adrenal adenoma on MRI liver imaging. She had recently developed hypertension and pre-diabetes, accompanied by a one-year history of symptoms consistent with Cushing’s syndrome. Initial investigations showed biochemistry consistent with a diagnosis of adrenal Cushing’s syndrome without evidence of co-secretion. Medical therapy with metyrapone was tolerated well and the patient reported a marked improvement in her symptoms with a return of menstruation. She was referred to the endocrine surgical team for consideration of a right adrenalectomy. On review of imaging, there was concern that the adrenal gland had adhered to the liver at the site of the previous surgery and a surgical approach was not without significant risk. Emerging evidence from the FABULAS trial supports the use of radiofrequency ablation (RFA) for aldosterone-secreting adrenal adenomas¹. However, its application in cortisol-secreting lesions remains underreported. Given the patient’s surgical risk, CT-guided percutaneous RFA was performed under general anaesthesia in January 2025. The procedure was uncomplicated, and the patient was discharged on hydrocortisone. A 9 a.m. cortisol measured four days post-procedure (off hydrocortisone) was 28 nmol/l, confirming biochemical remission. Apart from transient infective complications, she has remained well on 7 mg prednisolone once daily. This case demonstrates the potential role of CT-guided RFA as a safe and effective alternative to surgery for functioning adrenal adenomas in patients unsuitable for surgical intervention. Further research is warranted to define its efficacy and long-term outcomes in cortisol-secreting adrenal tumours.

Reference 1. Argentesi et al (2025) ‘Endoscopic, ultrasound-guided, radiofrequency ablation of aldosterone-producing adenomas (FABULAS): a UK, multicentre, prospective, proof-of-concept trial’ The Lancet. 405, 10479 p637-647.