A groundbreaking minimally invasive therapy has been developed by researchers at University College London (UCL), Queen Mary University of London, and Barts Health to treat a common cause of high blood pressure—primary aldosteronism. This condition affects around one in three adults in the UK, with estimates suggesting that about one in twenty cases are due to primary aldosteronism.
Primary aldosteronism occurs when tiny benign nodules grow on one or both adrenal glands and produce excess aldosterone, a hormone that increases blood pressure by raising salt levels. Patients suffering from this condition often do not respond well to standard blood pressure medications and face higher risks of heart attack, stroke, kidney failure, and other serious health issues.
The FABULAS study findings published in The Lancet describe initial results for Targeted Thermal Therapy (Triple T), which was tested on 28 patients with primary aldosteronism whose molecular scans pinpointed hormone-producing nodules in their left adrenal glands. Triple T offers a safer and faster alternative to surgery, by selectively destroying the small adrenal nodules without removing the entire gland.
This innovative treatment combines recent advancements in diagnostic scanning, using molecular dyes that accurately identify even the smallest nodules with two well-established medical techniques: microwaves generate heat within a tiny needle placed into abnormal tissue, causing a controlled burn; while ultrasound uses reflected sound waves to create real-time imaging of the procedure.
In Triple T, an internal camera equipped with both light and ultrasound technology is inserted through the mouth into the stomach. The endoscopist visualizes the adrenal gland and guides a fine needle from there precisely into the nodule. Short bursts of heat destroy the nodules while leaving healthy surrounding tissues unharmed.
This minimally invasive approach takes only 20 minutes, requires no internal or external incisions, and results were found to be both safe and effective. Most patients experienced normal hormone levels six months later; many participants even stopped taking their blood pressure medications entirely with no recurrence of the condition detected.
Triple T (also known scientifically as endoscopic ultrasound-guided radiofrequency ablation) was rigorously tested in collaboration with researchers from University College Hospital (UCLH), Cambridge University NHS Trust, and Queen Mary University of London. If further testing confirms these initial results, Triple T could benefit millions of people worldwide who are currently undiagnosed and untreated for high blood pressure caused by primary aldosteronism.
Currently, the only effective cure for this condition is surgical removal of entire adrenal glands—a procedure requiring general anesthesia, a two-to-three-day hospital stay, and weeks of recovery. Consequently, many patients go without treatment because of these drawbacks. The adrenal glands regulate important bodily functions such as blood pressure and metabolism; they also produce vital hormones including cortisol, adrenaline, and noradrenaline which play essential roles in boosting organ function during stress.
The success of the FABULAS study has led to a larger randomized trial called ‘WAVE’, comparing Triple T with traditional adrenal surgery on 120 patients. Results from this ongoing study are expected by 2027.
