Successful Radiofrequency Ablation of an Intrathyroidal Parathyroid Adenoma After Failed Parathyroidectomy.

Background/objective: Radiofrequency ablation (RFA) has been increasingly used as an alternative to surgery in patients with primary hyperparathyroidism who are unable or unwilling to have surgery.

Case Report: We present a case of a 64-year-old woman who had surgery for primary hyperparathyroidism complicated by osteoporosis. Preoperative imaging with 4-dimensional computed tomography scan suggested multigland disease; however, she had persistent hyperparathyroidism after parathyroid exploration.

Association Between Size of Dominant Candidate Lesion on Four-Dimensional CT and Four-Gland Hyperplasia among Patients with Primary Hyperparathyroidism.

Background: Four-dimensional (4D) CT localization allows minimally invasive parathyroidectomy as treatment for primary hyperparathyroidism (PHPT), but false positive localization is frequent. We sought to characterize the ability of 4D CT to predict four-gland hyperplasia (HP) based on the size of candidate lesions.

Study Design: We retrospectively analyzed patients with PHPT who underwent 4D CT imaging and parathyroidectomy between 2014 and 2020 from a prospectively collected institutional database.

Diagnostic Impact of Adrenal Vein Sampling in Adrenal Cushing's Syndrome.

Background: Adrenal Cushing's syndrome is characterized by ACTH-independent hypercortisolism. Adrenal vein sampling (AVS) is not routinely employed prior to management decisions, and few studies have investigated the value of AVS in this population. We assessed whether AVS provides a diagnostic benefit for treatment planning.

Radiofrequency ablation treatment for aldosterone-producing adenomas.

Purpose Of Review: To review the current status of radiofrequency ablation as a primary treatment for hyperfunctioning adrenal nodules, predominantly aldosterone-producing adenomas (APAs).

Recent Findings: Radiofrequency ablation is an established treatment for focal benign and malignant lesions, including metastatic disease to the adrenal gland. Hyperaldosteronism is the leading cause of secondary hypertension with up to 80% due to APA, statistically the most common functioning adrenal nodule.

Clinical Outcomes following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma: Comparison with Adrenalectomy.

Purpose: To compare adrenal radiofrequency (RF) ablation with adrenalectomy in treating unilateral aldosterone-producing adenoma (APA).

Materials And Methods: Between April 2008 and September 2013, 44 patients with adrenal venous sampling-confirmed (lateralization index ≥ 4) unilateral APA underwent adrenal RF ablation (12/44 [27%]) or adrenalectomy (32/44 [73%]). Outcomes of adrenal RF ablation (patient age, 51 y ± 11; 4/12 men) were compared with adrenalectomy (patient age, 50 y ± 11; 19/32 men).

Adrenal venous sampling: promises and pitfalls.

Purpose Of Review: To describe the current indications for adrenal vein sampling (AVS), variability in institutional protocols for performing the procedure, shortage of expert interventional radiologists trained in this procedure, pitfalls in technique and strategies to improve success. A major emphasis of the review will focus on the interpretation of the AVS results.

Recent Findings: Published protocols for performance of the AVS procedure and variability in the diagnostic criteria differentiating aldosterone-producing adenoma from bilateral adrenal hyperplasia vary significantly.

Embolotherapy for lower urinary tract hemorrhage.

The patient characteristics, techniques used, and outcomes of 11 patients with lower urinary tract hemorrhage treated with embolotherapy are described. The authors focus on bilateral superselective embolization of the arterial supply to the bladder and techniques to embolize multiple small vessels supplying the bladder when the vascular anatomy is complicated and superselective catheterization is not possible. The immediate success rate was 100%, with three later recurrences.