Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
Radiology. 2011 Jan;258(1):308-16. doi: 10.1148/radiol.10100690. Epub 2010 Oct 27.
To evaluate the use of radiofrequency (RF) ablation as a primary treatment for symptomatic primary functional adrenal neoplasms and determine the efficacy of treatment with use of clinical and biochemical follow-up.
After obtaining institutional review board approval, the authors retrospectively evaluated images and medical records from 13 consecutive patients with symptomatic functional adrenal neoplasms (<3.2 cm in diameter) who underwent RF ablation during a 7-year period. There were six men and seven women with a mean age of 54.1 years (range, 42-71 years). Cross-sectional images, findings from clinical examination, and adrenal biochemical markers were available for all patients. Ten of the 13 patients (77%) had an aldosteronoma and one patient each had a cortisol-secreting tumor, testosterone-secreting tumor, and pheochromocytoma. RF ablation was performed by two radiologists using an internally cooled electrode and a pulsed technique according to manufacturer's specifications. Clinical and laboratory follow-up was performed for all patients. Three patients underwent imaging follow-up for other reasons.
All patients demonstrated resolution of abnormal biochemical markers after ablation (mean biochemical follow-up, 21.2 months). In addition, all patients experienced resolution of clinical symptoms or syndromes, including hypertension and hypokalemia (in patients with aldosteronoma), Cushing syndrome (in the patient with cortisol-secreting tumor), virilizing symptoms (in the patient with testosterone-secreting tumor), and hypertension (in the patient with pheochromocytoma). For the patients with aldosteronoma, improvements in hypertension management were noted. The mean blood pressure before ablation was 149/90 mm Hg with a mean (±standard deviation) of 3.1 ± 0.6 blood pressure medications, and this decreased to 122/77 mm Hg at a mean of 2.8 months after ablation with 1.3 ± 0.9 medications (P < .001) and 124/75 mm Hg at a mean of 41.4 months. There were two minor complications: one small pneumothorax and one limited hemothorax, neither of which required overnight admission. There were two episodes of transient self-remitting procedural hypertension-one in a patient with aldosteronoma and one in the patient with a cortisol-secreting tumor; however, none of these patients required further therapy during overnight observation.
RF ablation may be an effective, minimally invasive method for treating small functional primary adrenal tumors.
评估射频（RF）消融作为治疗有症状的原发性功能性肾上腺肿瘤的主要手段，并通过临床和生化随访来确定治疗效果。
在获得机构审查委员会批准后，作者回顾性评估了 13 例连续患者的图像和病历，这些患者在 7 年内因有症状的功能性肾上腺肿瘤（直径<3.2cm）接受了 RF 消融治疗。患者中有 6 名男性和 7 名女性，平均年龄为 54.1 岁（范围，42-71 岁）。所有患者均有横断面图像、临床检查结果和肾上腺生化标志物。13 例患者中有 10 例（77%）为醛固酮瘤，1 例为皮质醇分泌瘤，1 例为睾酮分泌瘤，1 例为嗜铬细胞瘤。RF 消融由两位放射科医生使用内部冷却电极和根据制造商规格的脉冲技术进行。所有患者均进行临床和实验室随访。有 3 名患者因其他原因进行了影像学随访。
所有患者在消融后均显示异常生化标志物得到缓解（平均生化随访时间为 21.2 个月）。此外，所有患者均经历了临床症状或综合征的缓解，包括高血压和低钾血症（醛固酮瘤患者）、库欣综合征（皮质醇分泌瘤患者）、男性化症状（睾酮分泌瘤患者）和高血压（嗜铬细胞瘤患者）。对于醛固酮瘤患者，高血压的治疗得到改善。消融前的平均血压为 149/90mmHg，平均（±标准差）使用 3.1±0.6 种降压药物，消融后 2.8 个月降至 122/77mmHg，平均使用 1.3±0.9 种药物（P<0.001），41.4 个月时降至 124/75mmHg。有两种轻微并发症：一例小量气胸和一例局限性血胸，均无需住院过夜。有两例短暂自限性手术期间高血压发作，一例发生在醛固酮瘤患者，一例发生在皮质醇分泌瘤患者，但在过夜观察期间，这些患者均无需进一步治疗。
RF 消融可能是治疗小的功能性原发性肾上腺肿瘤的一种有效、微创的方法。
