Interventional Treatment of Primary Aldosteronism

Abstract

A unilateral hyperfunctioning aldosteronoma is the cause of approximately one-third of clinically evident cases of primary aldosteronism. This translates to up to two million Americans with a potentially surgically remediable form of hypertension and one that is more virulent than its essential counterpart. Many of these patients are either unable – due to comorbidities – or unwilling to undergo surgical adrenalectomy. Minimally invasive, image-guided interventional modalities can provide alternative treatment options that include percutaneous ablation (thermal or cryoablation) and endovascular embolization. As with surgery, intervention requires prior confirmation of a unilateral functioning aldosteronoma with conclusive lateralization by adrenal vein sampling. Evidence is indeed sparse but preliminarily indicates a long-term clinical efficacy (significant reduction in blood pressure/number of antihypertensive medications and elimination of hypokalemia) in approximately 75% of patients. Considering the attractive safety profile and the fact that these procedures can be performed on an outpatient basis, percutaneous ablation is a viable option for non-surgical patients.