Adrenal Ablation Therapy for Unilateral Primary Aldosteronism: Pros and Cons

Recently, increasing numbers of papers have been published with regard to alternative therapies for unilateral PA other than conventional unilateral laparoscopic adrenalectomy. These include CT-guided radiofrequency ablation (RFA), transvenous RFA, catheter-based adrenal ablation (transarterial embolization) and medical therapy with a mineralocorticoid receptor (MR) antagonist (Fig. 1). Since treatment with MR antagonists is a lifelong treatment and not fundamental, alternative therapies are needed, particularly for unilateral PA patients who refuse surgery and cannot tolerate MR antagonist therapy. A randomized controlled trial of catheter-based adrenal ablation is definitely required in the future. As this procedure is now performed in very select centers worldwide and was developed not so long ago, it should be used cautiously as an alternative for unilateral PA after sufficient counseling. For now, laparoscopic adrenalectomy remains the treatment of choice for unilateral PA.