215 - Ablation as an Alternative to Surgery for Adrenal Cushing Syndrome: Preliminary Comparative Outcomes

Tuesday, April 14, 2026

4:12 PM - 4:21 PM ET

Presenting Author(s)

AM

Ahmad Maaly, MD

Postdoctoral Research Fellow
Beth Israel Deaconess Medical Center/Harvard Medical School, United States

Author/Co-author(s)

Oussama Metrouh, MD (he/him/his)

Post- doctorate Research Fellow
Beth Israel Deaconess Medical Center, United States
OM

Omar Msto Hussain Nasser, MD

Research Fellow
BIDMC, United States
SA

Salma A. S. A. S. Abosabie

MD/MSc Candidate
Julius-Maximilians-Universität Würzburg, Germany
CK

Charissa Kim, MD, PhD

Resident physician
Beth Israel Deaconness Medical Center, United States
Mohammed Elkholy, MD

Postdoctoral research fellow
The Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America, United States
MF

Mohamed Farghaly, MD

Postdoctoral research fellow
The Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, United States of America., United States
YA

Yossof Abouelnagah, MD

Post-doctoral Research Fellow
Beth Israel Deaconess Medical Center / Harvard Medical School, United States
Marwan H. Moussa, MD

Vascular and Interventional Radiologist
Beth Israel Deaconess Medical Center, United States

Purpose: To explore and compare radiofrequency ablation with surgery in treating patients with adrenal Cushing Syndrome.

Materials and Methods: This retrospective case series compared patients between 2014 and 2025 who underwent adrenalectomy or ablation for adrenal Cushing Syndrome. For each patient, the most recent available follow-up (at 2 weeks, 3 months, or 6 months) was used to assess clinical and biochemical outcomes. Treatment response was evaluated in three ways: (1) a negative post-treatment screening test for hypercortisolism, (2) overall clinical symptom improvement, and (3) improvement in hypertension or diabetes. Data collected included systolic and diastolic blood pressure (SBP, DBP), ACTH, cortisol, weight, glucose, and HbA1c, measured before and after the intervention. Outcomes were summarized descriptively and compared between groups.

Results: Eleven patients were included: six underwent adrenalectomy and five underwent ablation. Among surgical patients, 50% (3/6) had a negative screening test following treatment, 17% (1/6) showed overall symptom improvement, and 33% (2/6) improved in blood pressure or glycemic control. In the ablation group, 20% (1/5) had a negative screening test, 60% (3/5) had clinical improvement, and 20% (1/5) improved in blood pressure or diabetes.

SBP declined from 154 mmHg (121–170) to 116 mmHg (106–132) in the surgery group and from 145 mmHg (127–178) to 130 mmHg (115–138) in the ablation group. DBP fell from 84.5 mmHg (79–102) to 67 mmHg (58–70) with surgery and from 81 mmHg (78–90) to 70 mmHg (65–85) with ablation. Cortisol dropped from 14.6 to 9.1 µg/dL after surgery and from 11.3 to 10.6 µg/dL after ablation. ACTH rose post-surgery (7.5 → 12.7 pg/mL) but decreased slightly with ablation (8.5 → 7.0 pg/mL). Glucose declined in the surgery group (115 → 101 mg/dL) but increased slightly with ablation (142.5 → 148 mg/dL); HbA1c followed a similar pattern (7.05% → 6.55% vs 6.55% → 7.1%). Because follow-up occurred at different time points across patients, these biochemical results should be interpreted with caution. Adrenal insufficiency was not observed in the ablation group, while its full extent in the surgery group could not be determined due to limited follow-up data.

Conclusion: Adrenal ablation is emerging as a safe and effective treatment for Cushing syndrome, offering comparable outcomes to surgery in improving clinical symptoms and hypertension. It may carry an advantage in avoiding adrenal insufficiency, though further studies with larger cohorts are needed to validate these findings and clarify its role as an alternative to adrenalectomy.