Adrenal Adenoma Thermal Ablation

Background and indications

Percutaneous thermal ablation of adrenal adenoma (radiofrequency, microwave, or cryoablation) is a minimally invasive alternative to laparoscopic adrenalectomy for functional adrenal adenomas (Conn syndrome, Cushing syndrome, selected pheochromocytomas) or isolated adrenal metastases.

It is particularly indicated for patients with high surgical risk, significant comorbidities, or small tumors (< 4-5 cm).

Pre-procedure assessment

Assessment includes adrenal CT or MRI, complete hormonal panel (cortisol, aldosterone, renin, urinary catecholamines, DHEA-S), AVS if aldosteronism, and coagulation panel. For pheochromocytomas, prior alpha-adrenergic blockade is essential.

Procedure

Under general anesthesia and CT guidance, one or more ablation needles are inserted into the adenoma via posterior or lateral approach. Technique is chosen by size and location: radiofrequency or microwave for lesions < 3 cm, cryoablation for larger lesions or those near critical structures (ice ball margin is more visible). The procedure takes 45 to 90 minutes.

Results and scientific evidence

Published series report 90-100% technical success rate and hormonal normalization in 70-85% of functional adenoma cases. For isolated adrenal metastases, local control is 80-90% at 12 months. Thermal ablation offers results comparable to surgery with lower morbidity and faster recovery.

Risks and complications

Local pain (20-30%), pneumothorax (5-10% for high posterior approaches), transient peri-procedural hypertension (especially pheochromocytoma), retroperitoneal hematoma (< 3%). Post-ablation adrenal insufficiency is rare if only one adrenal is treated.

Recovery

24-48 hour hospitalization for monitoring. Hormonal follow-up at D1, D7, 1 and 3 months. CT follow-up at 1 and 6 months.

Practical information

The procedure is performed as a short inpatient stay. It is performed by a specialized interventional radiologist, in coordination with the endocrinologist and surgeon.