Endoscopic, ultrasound-guided, radiofrequency ablation of aldosterone-producing adenomas (FABULAS): a UK, multicentre, prospective, proof-of-concept trial

Giulia Argentesi, Xilin Wu, Alexander Ney, Emily Goodchild, Kate Laycock, Yun-Ni Lee, Russell Senanayake, James MacFarlane, Elizabeth Ng, Jessica Kearney, Sam O’Toole, Jackie Salsbury, Nick Carroll, Daniel Gillett, John A Tadross, Alison Marker, Edmund M Godfrey, George Goodchild, Jonathan P Bestwich, Prof Mark Gurnell, Heok Cheow, Prof Stephen P. Periera, Prof William M Drake, Prof Morris J Brown, FABULAS Study Group

07 February 2025

Five percent of all cases of hypertension are caused by the potentially curable cause – unilateral aldosterone-producing adrenal adenomas (APAs). Very often their localisation (via adrenal vein sampling – AVS) and removal (by laparoscopic adrenalectomy) are not appealing to patients. Another, less invasive,  method of detecting and treating APAs has been discovered by the FABULAS Study Group. Over a five year testing period, 44 patients were screened and 28 recruited. The recruited patients  underwent ablations using the new EUS-RFA technology with positive outcomes; complete or partial biochemical cure in 21 participants and complete or partial cure of hypertension in 12 participants after a 3 month period. These findings appear to offer a safe alternative to total adrenalectomy for the treatment of left sided APAs and could potentially cure primary aldosteronism and hypertension when most of the APA is ablated.