La radiologia medica

, Volume 121, Issue 10, pp 811–819 | Cite as

Comparison of radiofrequency ablation versus laparoscopic adrenalectomy for benign aldosterone-producing adenoma

  • Min-Hsin Yang
  • Yeu-Sheng Tyan
  • Yu-Hui Huang
  • Shao-Chuan Wang
  • Sung-Lang ChenEmail author



To retrospectively compare the safety and efficacy of radiofrequency ablation (RFA) with laparoscopic adrenalectomy (LA) in treating aldosterone-producing adenoma (APA) of the adrenal gland.

Materials and methods

From September 2009 to September 2013, seven patients, diagnosed with unilateral adrenal APA and underwent computed tomography (CT)-guided percutaneous RFA, were recruited in this retrospective study. Eighteen unilateral adrenal APA with the same tumor size (<25 mm) who underwent LA during the same interval were enrolled as control group. Treatment success was defined as complete tumor ablation on follow-up CT scan and normalization of serum aldosterone-to-renin ratio. We also compared “normalization ability” between RFA group and LA group. Normalization ability was defined as reduction in blood pressure, decrease in number of antihypertensive medicine use, reduction in serum aldosterone, and increase in serum potassium level.


There was no statistically significant demographic difference in both groups. The mean tumor size was 18 (8–25) mm in RFA and 19 (11–25) mm in LA groups, respectively. There was only one intra-procedure hypertensive crisis in the RFA group. No other complications needed further management in both groups. During an interval of 3–6 months of follow-up, the treatment success rate reached 100 % in the RFA group versus 94.4 % in the LA group. Normalization ability was statistically equivalent in the RFA and the LA group. Comparing with LA group, RFA group demonstrated with less post-operative pain (visual analog scale, 2.0 ± 1.16 vs. 4.22 ± 1.44, p < 0.001) and shorter operative time (105 ± 34 vs. 194 ± 58 min, p < 0.001).


CT-guided percutaneous RFA is effective, safe and is a justifiable alternative for patients who are reluctant or unfit for laparoscopic surgery for the treatment of APA.


Aldosteronism Adrenal Radiofrequency Ablation 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standards

This article does not contain animals performed by any of the authors.


  1. 1.
    Dunnick NR (1990) Hanson lecture. Adrenal imaging: current status. AJR Am J Roentgenol 154(5):927–936. doi: 10.2214/ajr.154.5.2108567 CrossRefPubMedGoogle Scholar
  2. 2.
    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327(14):1033. doi: 10.1056/nejm199210013271417 CrossRefPubMedGoogle Scholar
  3. 3.
    Gumbs AA, Gagner M (2006) Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metab 20(3):483–499. doi: 10.1016/j.beem.2006.07.010 CrossRefPubMedGoogle Scholar
  4. 4.
    Mayo-Smith WW, Dupuy DE (2004) Adrenal neoplasms: CT-guided radiofrequency ablation—preliminary results. Radiology 231(1):225–230. doi: 10.1148/radiol.2311031007 CrossRefPubMedGoogle Scholar
  5. 5.
    Wood BJ, Abraham J, Hvizda JL, Alexander HR, Fojo T (2003) Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases. Cancer 97(3):554–560. doi: 10.1002/cncr.11084 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Carrafiello G, Lagana D, Recaldini C, Giorgianni A, Ianniello A, Lumia D, D’Ambrosio A, Petulla M, Dionigi G, Fugazzola C (2008) Imaging-guided percutaneous radiofrequency ablation of adrenal metastases: preliminary results at a single institution with a single device. Cardiovasc Interv Radiol 31(4):762–767. doi: 10.1007/s00270-008-9337-1 CrossRefGoogle Scholar
  7. 7.
    Xiao YY, Tian JL, Li JK, Yang L, Zhang JS (2008) CT-guided percutaneous chemical ablation of adrenal neoplasms. AJR Am J Roentgenol 190(1):105–110. doi: 10.2214/AJR.07.2145 CrossRefPubMedGoogle Scholar
  8. 8.
    Welch BT, Atwell TD, Nichols DA, Wass CT, Callstrom MR, Leibovich BC, Carpenter PC, Mandrekar JN, Charboneau JW (2011) Percutaneous image-guided adrenal cryoablation: procedural considerations and technical success. Radiology 258(1):301–307. doi: 10.1148/radiol.10100631 CrossRefPubMedGoogle Scholar
  9. 9.
    Liu SY, Ng EK, Lee PS, Wong SK, Chiu PW, Mui WL, So WY, Chow FC (2010) Radiofrequency ablation for benign aldosterone-producing adenoma: a scarless technique to an old disease. Ann Surg 252(6):1058–1064. doi: 10.1097/SLA.0b013e318f66936 CrossRefPubMedGoogle Scholar
  10. 10.
    Wolf FJ, Dupuy DE, Machan JT, Mayo-Smith WW (2012) Adrenal neoplasms: effectiveness and safety of CT-guided ablation of 23 tumors in 22 patients. Eur J Radiol 81(8):1717–1723. doi: 10.1016/j.ejrad.2011.04.054 CrossRefPubMedGoogle Scholar
  11. 11.
    Nunes TF, Szejnfeld D, Xavier AC, Kater CE, Freire F, Ribeiro CA, Goldman SM (2013) Percutaneous ablation of functioning adrenal adenoma: a report on 11 cases and a review of the literature. Abdom Imaging 38(5):1130–1135. doi: 10.1007/s00261-013-9995-6 CrossRefPubMedGoogle Scholar
  12. 12.
    Uppot RN, Gervais DA (2013) Imaging-guided adrenal tumor ablation. AJR Am J Roentgenol 200(6):1226–1233. doi: 10.2214/AJR.12.10328 CrossRefPubMedGoogle Scholar
  13. 13.
    Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF Jr, Montori VM, Endocrine S (2008) Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93(9):3266–3281. doi: 10.1210/jc.2008-0104 CrossRefPubMedGoogle Scholar
  14. 14.
    Lencioni R, Goletti O, Armillotta N, Paolicchi A, Moretti M, Cioni D, Donati F, Cicorelli A, Ricci S, Carrai M, Conte PF, Cavina E, Bartolozzi C (1998) Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial. Eur Radiol 8(7):1205–1211. doi: 10.1007/s003300050536 CrossRefPubMedGoogle Scholar
  15. 15.
    Arima K, Yamakado K, Suzuki R, Matsuura H, Nakatsuka A, Takeda K, Sugimura Y (2007) Image-guided radiofrequency ablation for adrenocortical adenoma with Cushing syndrome: outcomes after mean follow-up of 33 months. Urology 70(3):407–411. doi: 10.1016/j.urology.2007.04.032 CrossRefPubMedGoogle Scholar
  16. 16.
    Mendiratta-Lala M, Brennan DD, Brook OR, Faintuch S, Mowschenson PM, Sheiman RG, Goldberg SN (2011) Efficacy of radiofrequency ablation in the treatment of small functional adrenal neoplasms. Radiology 258(1):308–316. doi: 10.1148/radiol.10100690 CrossRefPubMedGoogle Scholar
  17. 17.
    Orlacchio A, Bolacchi F, Chegai F, Bergamini A, Costanzo E, Del Giudice C, Angelico M, Simonetti G (2014) Comparative evaluation of percutaneous laser and radiofrequency ablation in patients with HCC smaller than 4 cm. Radiol Med (Torino) 119(5):298–308. doi: 10.1007/s11547-013-0339-y CrossRefGoogle Scholar
  18. 18.
    Al-Shaikh AA, Al-Rawas MM, Al-Asnag MA (2004) Primary hyperaldosteronism treated by radiofrequency ablation. Saudi Med J 25(11):1711–1714PubMedGoogle Scholar
  19. 19.
    Loffer FD, Pent D (1976) Laparoscopy in the obese patient. Am J Obstet Gynecol 125(1):104–107CrossRefPubMedGoogle Scholar
  20. 20.
    Williams MD, Murr PC (1993) Laparoscopic insufflation of the abdomen depresses cardiopulmonary function. Surg Endosc 7(1):12–16CrossRefPubMedGoogle Scholar
  21. 21.
    Curley SA (2010) Radiofrequency ablation leads to excellent local tumor control and durable longterm survival in specific subsets of early stage HCC patients confirming to the Milan criteria. Ann Surg 252(6):913–914. doi: 10.1097/SLA.0b013e3182034862 CrossRefPubMedGoogle Scholar
  22. 22.
    Brunt LM, Doherty GM, Norton JA, Soper NJ, Quasebarth MA, Moley JF (1996) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183(1):1–10PubMedGoogle Scholar
  23. 23.
    Salomon L, Soulie M, Mouly P, Saint F, Cicco A, Olsson E, Hoznek A, Antiphon P, Chopin D, Plante P, Abbou CC (2001) Experience with retroperitoneal laparoscopic adrenalectomy in 115 procedures. J Urol 166(1):38–41CrossRefPubMedGoogle Scholar
  24. 24.
    Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, Gervais D, Gillams AR, Kane RA, Lee FT Jr, Livraghi T, McGahan J, Phillips DA, Rhim H, Silverman SG (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235(3):728–739. doi: 10.1148/radiol.2353042205 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y (2001) The visual analog scale for pain: clinical significance in postoperative patients. Anesthesiology 95(6):1356–1361CrossRefPubMedGoogle Scholar
  26. 26.
    Lee S, Rhim H, Kim YS, Choi D, Lee WJ, Lim HK, Shin B (2009) Percutaneous radiofrequency ablation of hepatocellular carcinomas: factors related to intraprocedural and postprocedural pain. AJR Am J Roentgenol 192(4):1064–1070. doi: 10.2214/ajr.08.1350 CrossRefPubMedGoogle Scholar
  27. 27.
    van Eekeren RR, Boersma D, Konijn V, de Vries JP, Reijnen MM (2013) Postoperative pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins. J Vasc Surg 57(2):445–450. doi: 10.1016/j.jvs.2012.07.049 CrossRefPubMedGoogle Scholar
  28. 28.
    Goldberg SN, Gazelle GS, Dawson SL, Rittman WJ, Mueller PR, Rosenthal DI (1995) Tissue ablation with radiofrequency using multiprobe arrays. Acad Radiol 2(8):670–674PubMedGoogle Scholar
  29. 29.
    Ethier MD, Beland MD, Mayo-Smith W (2013) Image-guided ablation of adrenal tumors. Tech Vasc Interv Radiol 16(4):262–268. doi: 10.1053/j.tvir.2013.08.008 CrossRefPubMedGoogle Scholar
  30. 30.
    Szejnfeld D, Nunes TF, Giordano EE, Freire F, Ajzen SA, Kater CE, Goldman SM (2015) Radiofrequency ablation of functioning adrenal adenomas: preliminary clinical and laboratory findings. J Vasc Interv Radiol 26(10):1459–1464. doi: 10.1016/j.jvir.2015.06.019 CrossRefPubMedGoogle Scholar
  31. 31.
    Mattsson C, Young WF Jr (2006) Primary aldosteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol 2(4):198–208. doi: 10.1038/ncpneph0151 (quiz, 191 p following 230) CrossRefPubMedGoogle Scholar
  32. 32.
    Mulatero P, Monticone S, Bertello C, Viola A, Tizzani D, Iannaccone A, Crudo V, Burrello J, Milan A, Rabbia F, Veglio F (2013) Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 98(12):4826–4833. doi: 10.1210/jc.2013-2805 CrossRefPubMedGoogle Scholar
  33. 33.
    Savard S, Amar L, Plouin PF, Steichen O (2013) Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 62(2):331–336. doi: 10.1161/HYPERTENSIONAHA.113.01060 CrossRefPubMedGoogle Scholar
  34. 34.
    Chini EN, Brown MJ, Farrell MA, Charboneau JW (2004) Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. Anesth Analg 99(6):1867–1869. doi: 10.1213/01.ANE.0000136803.54212.E1 (table of contents) CrossRefPubMedGoogle Scholar
  35. 35.
    Onik G, Onik C, Medary I, Berridge DM, Chicks DS, Proctor LT, Winter TC 3rd, Lee FT Jr (2003) Life-threatening hypertensive crises in two patients undergoing hepatic radiofrequency ablation. AJR Am J Roentgenol 181(2):495–497. doi: 10.2214/ajr.181.2.1810495 CrossRefPubMedGoogle Scholar
  36. 36.
    Keeling AN, Sabharwal T, Allen MJ, Hegarty NJ, Adam A (2009) Hypertensive crisis during radiofrequency ablation of the adrenal gland. J Vasc Interv Radiol 20(7):990–991. doi: 10.1016/j.jvir.2009.03.039 CrossRefPubMedGoogle Scholar
  37. 37.
    Venkatesan AM, Locklin J, Dupuy DE, Wood BJ (2010) Percutaneous ablation of adrenal tumors. Tech Vasc Interv Radiol 13(2):89–99. doi: 10.1053/j.tvir.2010.02.004 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2016

Authors and Affiliations

  • Min-Hsin Yang
    • 1
  • Yeu-Sheng Tyan
    • 2
  • Yu-Hui Huang
    • 3
    • 4
  • Shao-Chuan Wang
    • 1
  • Sung-Lang Chen
    • 1
    • 4
    Email author
  1. 1.Department of UrologyChung Shan Medical University HospitalTaichungTaiwan
  2. 2.Department of Medical ImagingChung Shan Medical University HospitalTaichungTaiwan
  3. 3.Department of Physical Medicine and RehabilitationChung Shan Medical University HospitalTaichungTaiwan
  4. 4.School of MedicineChung Shan Medical UniversityTaichungTaiwan

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