Image-guided radiofrequency ablation for adrenocortical adenoma with Cushing syndrome: Outcomes after mean follow-up of 33 months

Objectives To evaluate the feasibility, safety, and therapeutic effects of image-guided radiofrequency (RF) ablation used for the treatment of adrenocortical adenoma with Cushing syndrome. Methods From February 2003 to May 2005, 4 consecutive patients with adrenocortical adenoma and Cushing syndrome received percutaneous RF ablation. All tumors were in the left adrenal gland, with a mean tumor size of 2.7 +/- 0.6 cm (range 2.0 to 3.5). The RF ablation was performed under real-time computed tomography fluoroscopic guidance. Technical success was defined as disappearance of tumor enhancement on contrast-enhanced computed tomography imaging acquired within I week after RF ablation. Clinical success was defined as improvement in serum cortisol and adrenocorticotropic hormone values and symptoms at the end of follow-up. Results Tumor enhancement disappeared after initial RF ablation in 3 of 4 patients (technical success rate 75%). The fourth patient underwent a repeat RF ablation session 3 years later, resulting in eradication of tumor enhancement. Both the serum cortisol and adrenocorticotropic hormone levels returned to normal and the symptoms related to Cushing syndrome had disappeared at the end of follow-up (range 20 to 46 months, mean 33) for a clinical success rate of 100%. All tumors showed involution (2.2 +/- 0.3 cm) at the end of the study. No major complications occurred related to the procedures except for pneumothorax requiring chest tube placement for 3 days. Conclusions Using RF ablation for adrenocortical adenoma with Cushing syndrome is a feasible, safe, and promising treatment method in selected patients.