Ammar Sarwar MD, Presenter: Nothing to Disclose

Ari Charles Sacks MD, Abstract Co-Author: Nothing to Disclose

Olga Rachel Brook MD, Abstract Co-Author: Research Grant, Guerbet SA

Erica Alice Gupta MD, Abstract Co-Author: Nothing to Disclose

Nahum Goldberg, Abstract Co-Author: Nothing to Disclose

Barry A. Sacks MD, Abstract Co-Author: Nothing to Disclose

Muneeb Ahmed MD, Abstract Co-Author: Nothing to Disclose

Salomao Faintuch MD, Abstract Co-Author: Nothing to Disclose

To report and compare outcomes in patients undergoing radiofrequency ablation (RFA), surgical and medical treatment for primary hyperaldosteronism.  

In this IRB-approved, HIPAA-compliant retrospective study 117 consecutive patients undergoing adrenal vein sampling (AVS) were included in the study. Follow-up data was available in 92/117 patients (age 52±12, 44% female). 41/92 (44%) patients had medical treatment, 37/92 (40%) had adrenalectomy and 14/92 (15%) had RFA. Changes in systolic and diastolic blood pressure (SBP, DBP), number of anti-hypertensive medications (anti-HTN) and plasma renin to aldosterone ratios (ARR) were recorded on clinical follow-up.

RFA group: Clinical follow-up was performed 73±40 days post-RFA. Blood pressure decreased from 148±18/92±15 pre-RFA to 135±22/82±12 post-RFA (SBP: p<0.05, DBP: p=NS. Number of anti-HTN drugs decreased from 3.1±1.4 pre-RFA to 1.9±1.7 post-RFA (p=0.01).  Adrenalectomy group: Clinical follow-up was performed 33±40 days after surgery. Blood pressure decreased from 145±9.7/89±8.6 pre-surgery to 137±20/83±11post-surgery (SBP: <0.0001, DBP: NS). Pre-adrenalectomy patients were on 2.6±1.0 anti-HTN vs. 1.1±1.1 after surgery (p<0.0001).  Medical treatment group: Clinical follow-up was available in all patients, 48±255 days after AVS. Pre-AVS blood pressure was 144±19/88±12 vs. 136±20/83±11 post therapy (SBP: p=0.02, DBP: p=0.006). The patients on medical therapy were on an average of 3.1±1.8 anti-HTN medications prior to the AVS and an average of 3.3±1.8 on follow-up (p=N.S.).  Whereas there was a decrease in hypertension and anti-HTN needed for control after treatment, in the surgical group (p<0.001) and the RFA group (p=0.003) compared to the medical therapy group, there was no significant difference in the change in anti-HTN after treatment between the surgical and RFA group (p=0.07). The percentage of responders-to-therapy (Figure 1) in the surgical and RFA group were similar (p=0.06) but lower in the medical therapy group.  

RFA is a successful treatment for AVS-proven aldosterone producing adenomas with clinical outcomes comparable to adrenalectomy.

RFA is a successful treatment for primary hyperaldosteronism lateralizing to one gland on AVS with outcomes comparable to adrenalectomy, with the advantages of no incision, same day discharge and early return to daily activities.

Sarwar, A, Sacks, A, Brook, O, Gupta, E, Goldberg, N, Sacks, B, Ahmed, M, Faintuch, S, Clinical Outcomes in Primary Hyperaldosteronism Treatment: Radiofrequency Ablation vs. Adrenalectomy vs. Medical Therapy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045464.html