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DOI: 10.1055/s-0042-118165
Cushing’s syndrome managed by endoscopic ultrasound-guided radiofrequency ablation of adrenal gland adenoma
Publikationsverlauf
Publikationsdatum:
09. Januar 2017 (online)
![](https://www.thieme-connect.de/media/endoscopy/2017S01/lookinside/thumbnails/14412_10-1055-s-0042-118165-1.jpg)
A 38-year-old woman presented with “moon face,” “buffalo hump,” and weight gain of 9 kg in 12 months. Overnight, 1 mg dexamethasone failed to suppress the morning level of cortisol, and the 24-hour urine cortisol level was elevated to 101 μg/day (normal range 0 – 50). Initial contrast-enhanced abdominal computed tomography (CT) showed a 2.8-cm left adrenal mass enhanced in arterial phase, and the patient was diagnosed with Cushing’s syndrome due to left adrenal adenoma ([Fig. 1 a]). She refused surgical treatment but agreed to undergo endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA; STARmed, Koyang, Korea) ([Video 1]).
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-118165-i14412cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Qualität:
Prior to RFA, contrast-enhanced EUS with SonoVue (Bracco, Inc., Milan, Italy) was performed. Findings of early enhancement and delayed washout were compatible with adrenal adenoma ([Fig. 2 a]).
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-118165-i14412cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
A 19-guage needle electrode was positioned inside the adenoma. Using real-time EUS imaging, RFA (50 W) was performed at five different sites ([Fig. 2 b]).
Four days later contrast-enhanced EUS revealed viable tissue remaining at the marginal edge of the previously ablated portion of the adenoma ([Fig. 3 a]). EUS-RFA was repeated at five more sites in the remaining viable tissue ([Fig. 3 b]).
![](https://www.thieme-connect.de/media/endoscopy/2017S01/thumbnails/10-1055-s-0042-118165-i14412cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Follow-up CT at 1 week showed the adrenal mass almost completely replaced with necrotic tissue, without complications ([Fig. 1 b]). Serum and urine cortisol levels returned to normal the following day and remained normal for the next 2 months, with no adverse events related to RFA. However after the third month, the cortisol levels were re-elevated and this time the patient agreed to surgery.
Until recently, there were only a few case reports of RFA for the treatment of Cushing’s syndrome; all of them were treated via the CT-guided percutaneous method [1] [2]. The present case is the first in which EUS-RFA was used to manage Cushing’s syndrome caused by adrenal adenoma. This case report supports EUS-RFA as a safe and feasible alternative method that should be considered in patients who refuse surgical treatment. Further evidence and experiences are required.
Endoscopy_UCTN_Code_TTT_1AS_2AD
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References
- 1 Nishi N, Tanaka J, Minagawa A. Cushing syndrome treated by radiofrequency ablation of adrenal gland adenoma. Jpn J Radiol 2012; 30: 274-276
- 2 Nunes TF, Szejnfeld D, Xavier AC. et al. Percutaneous ablation of functioning adrenal adenoma: a report on 11 cases and a review of the literature. Abdom Imaging 2013; 38: 1130-1135