Skip to main content

Adrenal Interventions

  • Chapter
Interventional Urology

Abstract

Percutaneous ablative therapies appear to be effective approach to manage patients who are poor surgical candidates, due to either multiple comorbidities or metastatic disease. All modalities have scant but promising data for ablation of adrenal tumors and all need to be investigated more fully to determine their true safety and usefulness in the adrenal gland. While these techniques may be well established in other organs, the intricacies of the adrenal gland make it a challenging treatment location. As more data becomes available, the role of minimally invasive ablative techniques for adrenal tumors will be better characterized and treatment algorithms standardized.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Young Jr WF. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356(6):601–10.

    Article  CAS  PubMed  Google Scholar 

  2. Barzon L, et al. Prevalence and natural history of adrenal incidentalomas. Eur J Endocrinol. 2003;149(4):273–85.

    Article  CAS  PubMed  Google Scholar 

  3. Tsitouridis I, et al. CT guided percutaneous adrenal biopsy for lesions with equivocal findings in chemical shift MR imaging. Hippokratia. 2008;12(1):37–42.

    PubMed Central  CAS  PubMed  Google Scholar 

  4. Wagnerova H, Lazurova I, Felsoci M. Adrenal metastases. Bratisl Lek Listy. 2013;114(4):237–40.

    CAS  PubMed  Google Scholar 

  5. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66(5):607–18.

    Article  CAS  Google Scholar 

  6. Aronova A, Iii TJ, Zarnegar R. Management of hypertension in primary aldosteronism. World J Cardiol. 2014;6(5):227–33.

    PubMed Central  PubMed  Google Scholar 

  7. Bittner JGT, Brunt LM. Evaluation and management of adrenal incidentaloma. J Surg Oncol. 2012;106(5):557–64.

    Article  PubMed  Google Scholar 

  8. Icard P, et al. Adrenocortical carcinomas: surgical trends and results of a 253-patient series from the French Association of Endocrine Surgeons study group. World J Surg. 2001;25(7):891–7.

    Article  CAS  PubMed  Google Scholar 

  9. Sharma KV, et al. Image-guided adrenal and renal biopsy. Tech Vasc Interv Radiol. 2010;13(2):100–9.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Arnaldi G, Boscaro M. Adrenal incidentaloma. Best Pract Res Clin Endocrinol Metab. 2012;26(4):405–19.

    Article  CAS  PubMed  Google Scholar 

  11. Groussin L, et al. 18F-Fluorodeoxyglucose positron emission tomography for the diagnosis of adrenocortical tumors: a prospective study in 77 operated patients. J Clin Endocrinol Metab. 2009;94(5):1713–22.

    Article  CAS  PubMed  Google Scholar 

  12. Arellano RS, et al. Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications. Curr Probl Diagn Radiol. 2003;32(1):3–10.

    Article  PubMed  Google Scholar 

  13. Mazzaglia PJ, Monchik JM. Limited value of adrenal biopsy in the evaluation of adrenal neoplasm: a decade of experience. Arch Surg. 2009;144(5):465–70.

    Article  PubMed  Google Scholar 

  14. Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. AJR Am J Roentgenol. 2008;190(5):1163–8.

    Article  PubMed  Google Scholar 

  15. Song JH, Chaudhry FS, Mayo-Smith WW. The incidental indeterminate adrenal mass on CT (>10 H) in patients without cancer: is further imaging necessary? Follow-up of 321 consecutive indeterminate adrenal masses. AJR Am J Roentgenol. 2007;189(5):1119–23.

    Article  PubMed  Google Scholar 

  16. BRIDGE Study Investigators. Bridging anticoagulation: is it needed when warfarin is interrupted around the time of a surgery or procedure? Circulation. 2012;125(12):e496–8.

    Article  Google Scholar 

  17. Ahrar K, Gupta S. Percutaneous image-guided biopsy. New York: Springer; 2014. x, 375 pages.

    Book  Google Scholar 

  18. Kane NM, et al. Percutaneous biopsy of left adrenal masses: prevalence of pancreatitis after anterior approach. AJR Am J Roentgenol. 1991;157(4):777–80.

    Article  CAS  PubMed  Google Scholar 

  19. Bernardino ME, et al. CT-guided adrenal biopsy: accuracy, safety, and indications. AJR Am J Roentgenol. 1985;144(1):67–9.

    Article  CAS  PubMed  Google Scholar 

  20. Heaston DK, et al. Narrow gauge needle aspiration of solid adrenal masses. AJR Am J Roentgenol. 1982;138(6):1143–8.

    Article  CAS  PubMed  Google Scholar 

  21. Mody MK, Kazerooni EA, Korobkin M. Percutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr. 1995;19(3):434–9.

    Article  CAS  PubMed  Google Scholar 

  22. Gervais D, Sabharwal T. Interventional radiology procedures in biopsy and drainage, Techniques in interventional radiology. London/New York: Springer; 2011. xiv, 199 p.

    Book  Google Scholar 

  23. Sharma P, et al. Can hybrid SPECT-CT overcome the limitations associated with poor imaging properties of 131I-MIBG?: comparison with planar scintigraphy and SPECT in pheochromocytoma. Clin Nucl Med. 2013;38(9):e346–53.

    Article  PubMed  Google Scholar 

  24. de Agustin P, et al. Fine-needle aspiration biopsy of the adrenal glands: a ten-year experience. Diagn Cytopathol. 1999;21(2):92–7.

    Article  PubMed  Google Scholar 

  25. Saboorian MH, Katz RL, Charnsangavej C. Fine needle aspiration cytology of primary and metastatic lesions of the adrenal gland. A series of 188 biopsies with radiologic correlation. Acta Cytol. 1995;39(5):843–51.

    CAS  PubMed  Google Scholar 

  26. Welch TJ, et al. Percutaneous adrenal biopsy: review of a 10-year experience. Radiology. 1994;193(2):341–4.

    Article  CAS  PubMed  Google Scholar 

  27. Grumbach MM, et al. Management of the clinically inapparent adrenal mass (“incidentaloma”). Ann Intern Med. 2003;138(5):424–9.

    Article  PubMed  Google Scholar 

  28. Quayle FJ, et al. Needle biopsy of incidentally discovered adrenal masses is rarely informative and potentially hazardous. Surgery. 2007;142(4):497–502; discussion 502–4.

    Article  PubMed  Google Scholar 

  29. Saeger W, et al. High diagnostic accuracy of adrenal core biopsy: results of the German and Austrian adrenal network multicenter trial in 220 consecutive patients. Hum Pathol. 2003;34(2):180–6.

    Article  CAS  PubMed  Google Scholar 

  30. Fauci AS. Harrison’s principles of internal medicine. 17th ed. New York: McGraw-Hill; 2008.

    Google Scholar 

  31. Magill SB, et al. Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab. 2001;86(3):1066–71.

    CAS  PubMed  Google Scholar 

  32. McKenzie TJ, et al. Aldosteronomas – state of the art. Surg Clin North Am. 2009;89(5):1241–53.

    Article  PubMed  Google Scholar 

  33. Mulatero P, et al. Impact of different diagnostic criteria during adrenal vein sampling on reproducibility of subtype diagnosis in patients with primary aldosteronism. Hypertension. 2010;55(3):667–73.

    Article  CAS  PubMed  Google Scholar 

  34. Phillips JL, et al. Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma. J Clin Endocrinol Metab. 2000;85(12):4526–33.

    Article  CAS  PubMed  Google Scholar 

  35. Stewart PM, Allolio B. Adrenal vein sampling for Primary Aldosteronism: time for a reality check. Clin Endocrinol (Oxf). 2010;72(2):146–8.

    Article  Google Scholar 

  36. Young WF, et al. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136(6):1227–35.

    Article  PubMed  Google Scholar 

  37. Khan SL, Angle JF. Adrenal vein sampling. Tech Vasc Interv Radiol. 2010;13(2):110–25.

    Article  Google Scholar 

  38. Funder JW, Carey RM, Fardella C, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266–81.

    Article  CAS  PubMed  Google Scholar 

  39. Weinberger MH, Fineberg NS. The diagnosis of primary aldosteronism and separation of two major subtypes. Arch Intern Med. 1993;153(18):2125–9.

    Article  CAS  PubMed  Google Scholar 

  40. Young Jr WF, Hogan MJ. Renin-independent hypermineralocorticoidism. Trends Endocrinol Metab. 1994;5(3):97–106.

    Article  CAS  PubMed  Google Scholar 

  41. Rossi GP, Seccia TM, Pessina AC. Primary aldosteronism – part I: prevalence, screening, and selection of cases for adrenal vein sampling. J Nephrol. 2008;21(4):447–54.

    CAS  PubMed  Google Scholar 

  42. Lim PO, et al. Potentially high prevalence of primary aldosteronism in a primary-care population. Lancet. 1999;353(9146):40.

    Article  CAS  PubMed  Google Scholar 

  43. Vongpatasin W. Resistant hypertension: a review of diagnosis and management. JAMA. 2014;311(31):2216–24.

    Article  Google Scholar 

  44. Kempers MJ, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med. 2009;151(5):329–37.

    Article  PubMed  Google Scholar 

  45. Sacks BA, Brook OR, Brennan IM. Adrenal venous sampling: promises and pitfalls. Curr Opin Endocrinol Diabetes Obes. 2013;20(3):180–5.

    Article  PubMed  Google Scholar 

  46. Mathur A, et al. Consequences of adrenal venous sampling in primary hyperaldosteronism and predictors of unilateral adrenal disease. J Am Coll Surg. 2010;211(3):384–90.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Seccia TM, et al. Adrenocorticotropic hormone stimulation during adrenal vein sampling for identifying surgically curable subtypes of primary aldosteronism: comparison of 3 different protocols. Hypertension. 2009;53(5):761–6.

    Article  CAS  PubMed  Google Scholar 

  48. Rossi GP, et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab. 2012;97(5):1606–14.

    Article  CAS  PubMed  Google Scholar 

  49. Auchus RJ, et al. What we still do not know about adrenal vein sampling for primary aldosteronism. Horm Metab Res. 2010;42(6):411–5.

    Article  CAS  PubMed  Google Scholar 

  50. Rossi GP, et al. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 2014;63(1):151–60.

    Article  CAS  PubMed  Google Scholar 

  51. Carr CE, et al. Comparison of sequential versus simultaneous methods of adrenal venous sampling. J Vasc Interv Radiol. 2004;15(11):1245–50.

    Article  PubMed  Google Scholar 

  52. Nakamura Y, et al. 18-oxocortisol measurement in adrenal vein sampling as a biomarker for subclassifying primary aldosteronism. J Clin Endocrinol Metab. 2011;96(8):E1272–8.

    Article  CAS  PubMed  Google Scholar 

  53. Ethier MD, Beland MD, Mayo-Smith W. Image-guided ablation of adrenal tumors. Tech Vasc Interv Radiol. 2013;16(4):262–8.

    Article  PubMed  Google Scholar 

  54. Gunjur A, et al. Surgical and ablative therapies for the management of adrenal ‘oligometastases’ – a systematic review. Cancer Treat Rev. 2014;40(7):838–46.

    Article  PubMed  Google Scholar 

  55. Venkatesan AM, et al. Percutaneous ablation of adrenal tumors. Tech Vasc Interv Radiol. 2010;13(2):89–99.

    Article  PubMed Central  PubMed  Google Scholar 

  56. Tuncali K, et al. Evaluation of patients referred for percutaneous ablation of renal tumors: importance of a preprocedural diagnosis. AJR Am J Roentgenol. 2004;183(3):575–82.

    Article  PubMed  Google Scholar 

  57. Venkatesan AM, et al. Radiofrequency ablation of metastatic pheochromocytoma. J Vasc Interv Radiol. 2009;20(11):1483–90.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Atwell TD, et al. Malignant hypertension during cryoablation of an adrenal gland tumor. J Vasc Interv Radiol. 2006;17(3):573–5.

    Article  PubMed  Google Scholar 

  59. Arima K, et al. Image-guided radiofrequency ablation for adrenocortical adenoma with Cushing syndrome: outcomes after mean follow-up of 33 months. Urology. 2007;70(3):407–11.

    Article  PubMed  Google Scholar 

  60. Rhim H, et al. Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. Radiographics. 2001;21(Spec No):S17–35; discussion S36–9.

    Article  PubMed  Google Scholar 

  61. Wolf FJ, et al. Adrenal neoplasms: effectiveness and safety of CT-guided ablation of 23 tumors in 22 patients. Eur J Radiol. 2012;81(8):1717–23.

    Article  PubMed  Google Scholar 

  62. Wood BJ, et al. Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases. Cancer. 2003;97(3):554–60.

    Article  PubMed Central  PubMed  Google Scholar 

  63. Mendiratta-Lala M, et al. Efficacy of radiofrequency ablation in the treatment of small functional adrenal neoplasms. Radiology. 2011;258(1):308–16.

    Article  PubMed  Google Scholar 

  64. Beland MD, Mayo-Smith WW. Ablation of adrenal neoplasms. Abdom Imaging. 2009;34(5):588–92.

    Article  PubMed  Google Scholar 

  65. Tsoumakidou G, et al. Life-threatening complication during percutaneous ablation of adrenal gland metastasis: Takotsubo syndrome. Cardiovasc Intervent Radiol. 2010;33(3):646–9.

    Article  PubMed  Google Scholar 

  66. Li X, et al. CT-guided percutaneous microwave ablation of adrenal malignant carcinoma: preliminary results. Cancer. 2011;117(22):5182–8.

    Article  PubMed  Google Scholar 

  67. Xiao YY, et al. CT-guided percutaneous chemical ablation of adrenal neoplasms. AJR Am J Roentgenol. 2008;190(1):105–10.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adam R. Metwalli MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Taylor, M.A., Metwalli, A.R. (2016). Adrenal Interventions. In: Rastinehad, A., Siegel, D., Pinto, P., Wood, B. (eds) Interventional Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-23464-9_27

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-23464-9_27

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23463-2

  • Online ISBN: 978-3-319-23464-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics