This article is a collaboration between 鶹ý and:
ORLANDO -- A 65-year-old woman with an adrenal cortisol-producing tumor was successfully treated with radiofrequency ablation, researchers said here.
The woman had presented with weight gain, decreased energy, and muscle weakness, with a history of type 2 diabetes, hypertension, and low-grade ovarian cancer post total hysterectomy and omentectomy. Seven months after the procedure there was continued "drastic clinical improvement," according to , at the Advocate Christ Medical Center in Oak Lawn, Ill., who presented the findings during a press briefing at the annual meeting of the American Association of Clinical Endocrinologists.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
"Clinicians recognize this as a viable option for patients instead of adrenalectomy," said Lawrence in an interview with 鶹ý. Many patients don't qualify for adrenalectomy, she added, because they may have several other comorbidities or might have already undergone a surgical operation.
The woman had a mass of 0.9 cm that got bigger over the next 5 years -- increasing to 3.6 cm by 3.5 cm by 3.5 cm -- and an attenuation of 30.2 Hounsfield units. The woman was anxious and obese when she presented, according to the study. A laboratory evaluation showed that she had normal serum metanephrines, cortisol of 14.1 mcg/dL (3.0-23.0 mcg/dL), a normal urinary 24-hour free cortisol of 15.2 ug/d (<45 ug/d), and elevated late night salivary cortisol at 4.5 nmol/L (3.0-4.0 nmol/L).
The researchers reported that 1 mg of dexamethasone didn't suppress her morning cortisol level of 11.2 mcg/dL (3.0-23.0 mcg/dL). When they looked at her adrenocorticotropic hormone levels, they confirmed the diagnosis of a cortisol-secreting tumor. They planned an adrenalectomy but never went through with it because of a finding of peritoneal studding during the operation. A peritoneal biopsy then showed that she had metastatic ovarian cancer, so she underwent radiofrequency ablation.
Eight weeks after the procedure, the adrenal mass had reduced to 3.3 cm by 3.2 cm by 3.2 cm, while the attenuation of Hounsfield units dropped to 22; the size was similar 7 months later.
"Increasing evidence is emerging demonstrating the efficacy of percutaneous radiofrequency ablation for treatment of both adrenal metastases and functional adrenal tumors as an alternative for patients unable to undergo surgical intervention," wrote the authors. They cited a previous study showing that 13 patients with adrenal neoplasms had resolution of abnormal biochemical markers and clinical symptoms over 7 years after radiofrequency ablation.
But there are still no randomized controlled trials, said Lawrence. "What we really need are those kinds of studies of how radiofrequency ablation compares to adrenalectomy," she said. In theory, it would be good for a lot of patients: "They would have this other option that can reduce length of stay and reduce hospital costs, and can be done under local anesthesia and as an outpatient procedure," she said.
Disclosures
The authors disclosed no relationships with industry.
Primary Source
American Association of Clinical Endocrinology
Rodriguez A, et al "Radiofrequency ablation: an innovative treatment for adrenal neoplasms" AACE 2016; Abstract 115.