AACE 25th Annual Scientific & Clinical Congress:

Adrenal Neoplasms Treated Minimally Invasively Using Radiofrequency Ablation

Radiofrequency ablation (RFA), a minimally invasive procedure, was shown to be an innovative alternative to adrenalectomy in the treatment of adrenal neoplasms. Dr. Lima Lawrence presented a case study involving RFA at the American Association of Clinical Endocrinologist's (AACE) 25th Annual Scientific & Clinical Congress in Orlando, Florida.

adrenal gland situated above a kidney
Lima Lawrence, MD presented this novel research on behalf of her colleague, Aleida Roderiguiz, MD, who is the primary author of the abstract. Dr. Lawrence is currently an internal medicine resident at the University of Illinois, Chicago at Advocate Christ Medical Center in Oaklawn, IL. Dr. Lawrence received her medical degree from Medical University of Silesia in Katowice, Poland.

Case Study
A 65-year-old female presented with a right-sided adrenal cortisol-producing tumor that was originally diagnosed in 2005. She reported symptoms of weight gain, low energy and muscle weakness.

The patient's past medical history included connective tissue disease, type 2 diabetes, hypertension, and ovarian cancer (Treatment: ovariohysterectomy and partial omentectomy). Over a period of 9 years the size of the adrenal tumor increased to >3 cm with an attenuation of 30.2 Hounsfield units. Laboratory testing confirmed the diagnosis of a cortisol-secreting tumor causing Cushing's syndrome.

An adrenalectomy was planned, but stopped intraoperatively upon discovery of peritoneal studding. Subsequently, a CT-guided radiofrequency ablation of the right-sided adrenal mass was performed. At 8-weeks post RFA, CT imaging revealed the size of the mass had decreased. Furthermore, the patient reported an improvement in symptoms.

Adrenalectomy vs Radiofrequency Ablation
Adrenalectomy, removal of one or both adrenal glands, is typically performed via laparotomy (open incision) or laparoscopically (several small incisions) to treat adrenal neoplasms. These surgical procedures are not appropriate for all patients, such as those of advanced age or who have undergone contralateral adrenalectomy.
 
Radiofrequency ablation is a minimally invasive, percutaneous procedure considered in the treatment of tumors involving bone, liver, or kidneys. "RFA works by using alternating electrical current to generate heat and induce thermal damage and tissue necrosis at temperatures of 50-60°C in the area adjacent to the electrode tip," explained Dr. Lawrence.

"More recently, RFA has been used in the treatment of adrenal tumors. It is performed under ultrasound or CT by a trained and experienced interventional radiologist in an in- or out-patient setting," stated Dr. Lawrence. RFA can be performed using a local or general anesthesia. "RFA provides patients with an alternative treatment choice; one that is considered to be safe and effective." said Dr. Lawrence.

  • According to Mendiratta-Lala et al, "RF ablation may be an effective, minimally invasive method for treating small functional primary adrenal tumors." Furthermore, all the patients in that study experienced resolution of clinical symptoms (eg, hypertension, hypokalemia, Cushings).1
  • In a study by Szejnfeld et al, "Percutaneous [minimally invasive] RF ablation of functioning adrenal adenomas may result in normalization of hormone secretion, improvement in blood pressure, and reduced need for antihypertensive drugs."2

Conclusion
Further studies, including well-designed randomized clinical trials with long-term follow-up, are needed before radiofrequency ablation can be considered a standard of care in patients with adrenal tumors.

Dr. Lima Lawrence has no disclosures to report.

Source
Lawrence L. Radiofrequency Ablation: An Innovative Treatment for Adrenal Neoplasms. American Association of Clinical Endocrinologists (AACE) 25th Annual Scientific & Clinical Congress, Rosen Shingle Creek, Orlando, FL. May 25-29, 2016.

References
1. Mendiratta-Lala M, Brennan DD, Brook OR, Faintuch S, et al. Efficacy of Radiofrequency Ablation in the Treatment of Small Functional Adrenal Neoplasms. Radiology. Vol. 258, No. 1, January 2011.
2. Szejnfeld D, Nunes TF, Giordano EE, Freire F, et al. Radiofrequency Ablation of Functioning Adrenal Adenomas: Preliminary Clinical and Laboratory Findings. J Vas Interv Radio. 2015;26(10):1459-1464.

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