Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.
目的： 评估经导管肾上腺消融术治疗库欣综合征（CS）相关性高血压的可行性及疗效。 方法： 收集2018年3月至2023年7月于大坪医院接受经导管肾上腺消融术治疗的CS相关高血压患者。观察并记录术后并发症发生情况及血压（诊室血压及24 h动态血压）、体重、临床症状、生化指标水平［包括8：00皮质醇、8：00促肾上腺皮质激素（ACTH）以及24 h尿游离皮质醇（UFC）、空腹血糖］。将有效定义为血压降至正常［收缩压<140 mmHg（1 mmHg=0.133 kPa）和舒张压<90 mmHg］，8：00皮质醇和24 h UFC降至正常以及临床症状改善。术后1、3、6、12个月进行门诊随访复查上述指标。 结果： 共入选12例CS患者，年龄（40.0±13.2）岁，其中男性5例。影像学检查结果提示肾上腺腺瘤5例，肾上腺增生7例。所有病例均成功实施了经导管肾上腺消融术，无临时中止手术和转外科手术者，术后未发生局部穿刺部位出血、感染及消融手术造成的肾上腺动脉破裂、腺体出血等并发症。平均随访时间为28个月，术后体重［（59.48±11.65）kg比（64.81±10.75）kg，P=0.008］、空腹血糖［（4.54±0.83）mmol/L比（5.53±0.99）mmol/L，P=0.044］、诊室收缩压［（128±21）mmHg比（140±19）mmHg，P=0.005］、诊室舒张压［（78±10）mmHg比（86±11）mmHg，P=0.041］及日间舒张压平均值［（79±12）mmHg比（89±8）mmHg，P=0.034］均较术前降低。8例有效，有效组手术前后的24 h UFC差异有统计学意义［（1 338.41±448.06）mmol/L比（633.66±315.94）mmol/L，P=0.011］，有效组与无效组患者的24 h UFC变化率差异有统计学意义（P=0.020）。术后肾上腺腺瘤组的诊室收缩压低于肾上腺增生组［（112±13）mmHg比（139±20）mmHg，P=0.026］。 结论： 对于不愿或者不能行外科手术的CS相关性高血压患者，经导管肾上腺消融术可改善血压和皮质功能，是一种安全有效的微创治疗方法，但仍需大样本临床研究进一步验证。.