Endocrine Abstracts

Introduction: Primary aldosteronism (PA) is a rare but underestimated cause of hypertension. PA has been associated with increased risk of malignancy through mechanisms involving up-regulation of the renin angiotensin system (RAS) promoting an enzymatic cascade influencing carcinogenesis. Recently, Microwave Ablation (MWA) has been established as an effective and safe minimal invasive treatment for Conn’s Disease.

Aim: The authors present four clinical cases of successful treatment of PA with MWA in an oncological setting.

Patients and Methods: Retrospective review of patient’s files.

Results: Four women (mean age 55y; 37-67) with pre-diagnosed cancer (1 papillary thyroid carcinoma, one with both gastric carcinoma and Chronic Lymphocytic Leukaemia; one colon carcinoma in context of hereditary syndrome and one breast carcinoma) were evaluated in the Endocrinology Department of IPOFG Porto, either for hypertension and/or hypokalemia and adrenal nodules compatible with adenoma on imaging studies. One patient (pt.) was already treated with spironolactone because of long-term previously diagnosed PA. Renin/aldosterone tests confirmed PA in one pt. In two other pts. the diagnosis was based on the normalization of PA and potassium after spironolactone treatment as diagnosis was made under active cancer treatment. All the 4 pts. were submitted to adrenal adenoma MWA performed by the same Interventional Radiology skilled specialist. Soon after the procedure that occurred without peri-procedure complications, blood pressure and potassium normalized. Re-evaluation of the renin/angiotensin tests out of cancer treatment revealed normal aldosterone and renin levels. After a mean follow-up of 34 months (15-54) there is no evidence of recurrence and/or adrenal insufficiency.

Conclusion: MWA seems to be a long-term effective and safe alternative for the treatment of Conn’s adenomas, which is very important in the oncological setting. PA must be excluded in the evaluation of cancer patients with refractory hypertension and/or hypokalemia and adrenal incidentaloma. Orthodox evaluation of PA through traditional tests should be questioned in oncological pts. on active cancer treatment as it can interfere on test results and withdrawing of anti-hypertensive therapies may not be advised.