Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters |
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| Affiliation: | 1. Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C;2. School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C;3. Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon;1. Division of Interventional Radiology, Department of Radiology, University of Illinois Health, Chicago, Illinois;2. Department of Pathology, University of Illinois Health, Chicago, Illinois;3. Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois;4. Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-361, San Francisco, CA 94143;1. Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People’s Republic of China 410011;2. Department of General Surgery, Second Xiangya Hospital, Central South University, Number 139, Renmin Road, Changsha, Hunan, People’s Republic of China 410011;3. Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, People’s Republic of China;1. Therenva, 4 rue Jean Jaures, Rennes 35000, France;2. University Rennes 1, Signal and Image Processing Laboratory, INSERM, Rennes, France;3. Department of Cardiothoracic and Vascular Surgery, University Hospital Rennes, Rennes, France;1. Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Portland, Oregon;2. Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon;3. Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L-605, Portland, OR 97239;1. Department of Neurointervention, Prince of Wales and Liverpool Hospitals, PO Box 663, Randwick, Sydney NSW 2031, Australia;2. Neurological Intervention and Imaging Service of West Australia, Sir Charles Gairdner Hospital, Perth, Australia;3. Neurointervention Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia;4. Neurointervention Service, Royal Melbourne Hospital, Melbourne, Australia;5. Semmes-Murphey Clinic, Memphis, Tennessee;6. Cerebrovascular, Endovascular, and Skull Base Surgery, Center for Advanced Translational Stroke Science, University of Kentucky, Lexington, Kentucky;7. Nottingham University Hospital, Nottingham, United Kingdom;8. St. Georges Hospital, London, United Kingdom;9. UK Neurointerventional Group, Belfast Hospital Trust, Belfast, United Kingdom;10. UK Neurointerventional Group, North Bristol Hospitals NHS Trust, Bristol, United Kingdom;11. UEMS Neuroradiology Division, Karolinska University Hospital, Stockholm, Sweden;12. Interventional Neuroradiology Unit, University Hospital of Zurich, Zurich, Switzerland;13. Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;1. Biological Sciences Division, Pritzker School of Medicine, University of Chicago, 924 E. 57th Street, Suite 104, Chicago, IL 60637;2. Department of Radiology, University of Chicago Medical Center, University of Chicago, Chicago, Illinois |
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| Abstract: | PurposeTo assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma.Materials and MethodsA systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated.ResultsA total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (−29.06 mm Hg; 95% confidence interval [CI], −33.93 to −24.19), DBP (−16.03 mm Hg; 95% CI, −18.33 to −13.73), and the number of antihypertensive medications used (−1.43; 95% CI, −1.97 to −0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration.ConclusionsThermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results. |
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