Catecholamine Surge during Image-Guided Ablation of Adrenal Gland Metastases: Predictors, Consequences, and Recommendations for Management

Purpose: To identify retrospectively predictors of catecholamine surge during image-guided ablation of metastases to the adrenal gland. Materials and Methods: Between 2001 and 2014, 57 patients (39 men, 18 women; mean age, 65 y +/- 10; age range, 41-81 y) at two academic medical centers underwent ablation of 64 metastatic adrenal tumors from renal cell carcinoma (n = 27), lung cancer (n = 23), melanoma (n = 4), colorectal cancer (n = 3), and other tumors (n = 7). Tumors measured 0.7-11.3 cm (mean, 4 cm +/- 2.5). Modalities included cryoablation (n = 38), radiofrequency (RF) ablation (n = 20), RF ablation with injection of dehydrated ethanol (n = 10), and microwave ablation (n = 4). Fisher exact test, univariate, and multivariate logistical regression analysis was used to evaluate factors predicting hypertensive crisis (HC). Results: HC occurred in 31 sessions (43%). Ventricular tachycardia (n = 1), atrial fibrillation (n = 2), and troponin leak (n = 4) developed during HC episodes. HC was significantly associated with maximum tumor diameter <= 4.5 cm (odds ratio [OR], 26.36; 95% confidence interval [CI], 5.26-131.99; P < .0001) and visualization of nolinal adrenal tissue on CT or MR imaging before the procedure (OR, 8.38; 95% CI, 2.67-25.33; P < .0001). No HC occurred during ablation of metastases in previously irradiated or ablated adrenal glands. Conclusions: Patients at high risk of catecholamine surge during ablation of non hormonally active adrenal metastases can be identified by the presence of normal adrenal tissue and tumor diameter <= 4.5 cm on pre-procedure CT or MR imaging.