Unilateral
adrenalectomy is the standard treatment for patients with
aldosterone-producing
adenoma (APA), but it lacks an option for patients with APA who refuse or are not suitable for surgery. In this study, we studied whether
catheter-based adrenal ablation for APA is comparable to
adrenalectomy. A total of 2185 hypertensive patients were screened, and 112 patients with APA were recruited and counselled on the treatment options. Fifty-two patients opted for
catheter-based adrenal ablation, and 60 opted for
adrenalectomy. Clinical and biochemical outcomes were assessed at 6 months
after treatment. Factors associated with
hypertension remission and the advantages and limitations of this approach were evaluated. According to the primary
aldosteronism surgical outcome (PASO) criteria, complete and partial clinical success was achieved in 21 (40.4%) and 23 (44.2%) patients in the ablation group vs. 33 (55.0%) and 23 (38.3%) patients in the
adrenalectomy group, respectively. Complete and partial biochemical success was achieved in 30 (57.7%) and 17 (32.7%) patients in the ablation group vs. 51 (85.0%) and 5 (8.3%) patients in the
adrenalectomy group, respectively. The complete clinical success rate was not (P > 0.05), but the complete biochemical success rate was significantly different between the two groups (P < 0.01). Factors associated with adrenal ablation-mediated
hypertension remission were
hypertension duration and serum
potassium level at baseline. Compared with surgery, adrenal ablation requires a shorter operating time and time to resume physical activity.
Catheter-based adrenal ablation may be an alternative and feasible option for APA patients unwilling to receive surgical treatment.