SFEBES2022 Poster Presentations Adrenal and Cardiovascular (66 abstracts)
Preliminary data from FABULAS: a Feasibility study of RadioFrequency endoscopic ABlation, with ULtrasound guidance, as a non-surgical, Adrenal Sparing treatment for aldosterone producing adenomas
Giulia Argentesi 1 , Xilin Wu 1 , Emily Goodchild 1 , Kate Laycock 1 , Alexander Ney 2 , Russell Senanayake 3 , James MacFarlane 3 , George Goodchild 4 , Patrick Wilson 4 , Ed Godfrey 3 , Mark Gurnell 3 , Heok Cheow 3 , Stephen P Pereira 2 , William M Drake 5 & Morris J Brown 1
1Queen Marys University London, London, United Kingdom; 2University College Hospital London, London, United Kingdom; 3Cambridge University Hospital, Cambridge, United Kingdom; 4The Royal London Hospital, London, United Kingdom; 5St Bartholomews Hospital, London, United Kingdom
Primary aldosteronism (PA) is the potentially curable cause of high-risk hypertension in 5-10% of unselected patients. Diagnosis and lateralisation of PA is challenging and complex. Outcomes post total adrenalectomy, the standard treatment for unilateral aldosterone producing adenomas (APAs), are variable. Between 30-60% are cured (1), but prediction of outcome is unreliable, and some patients are reluctant to have abdominal surgery to remove a whole adrenal gland. Endoscopic ultrasound (EUS)-guided radiofrequency ablation (RFA) is an alternative treatment to surgery for epigastric malignancies but has rarely been attempted for adrenal lesions. Given the proximity of the left adrenal gland to the stomach, we conducted a multicentre pilot study of EUS-RFA for left-sided APAs and present here our preliminary results The primary outcome was a safety assessment of this procedure: the objective being to establish that rare events such as perforation, haemorrhage and infarction of major organs did not occur within the first 48 hours. 30 patients with a definite or probable left-sided APA were recruited: 24 males and 6 females. Patients had an average age of 56 years and either comorbidities dictating surgical caution; or had declined surgery (personal preference). Four clinically significant events occurred: hypokalaemia-induced-atrial fibrillation (AF) during the procedure in a patient with known paroxysmal AF; hospital acquired pneumonia; an ischaemic cerebral event 6 months post ablation; and a non-ST elevation myocardial infarction from occult atherosclerotic disease exacerbated by undergoing a general anaesthetic. An independent safety committee reviewed all events and considered all to be unrelated to the trans-gastric puncture. Clinical and biochemical outcomes (PASO) are being recorded at 6 months post-procedure. Preliminary evidence suggests EUS-RFA is a safe alternative to complete adrenalectomy for left-sided APAs.
Reference: 1. Funder, J.W. et al., The Management of Primary Aldosteronism. J Clin Endocrinol Metab, 2016.101(5): p. 1889-916.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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