Efficacy and Safety of Adrenal Artery Embolization for Idiopathic Hyperaldosteronism: A Systematic Review & Meta-Analysis.

PURPOSE: To evaluate the efficacy and safety of adrenal artery embolization for idiopathic hyperaldosteronism.

MATERIALS AND

METHODS

PubMed, Embase, and Cochrane databases were searched through June 2026. Studies reporting clinical outcomes after adrenal artery embolization for idiopathic hyperaldosteronism were included. Outcomes comprised 24-h ambulatory and home blood pressure, plasma aldosterone and renin, aldosterone-to-renin ratio, serum potassium and cortisol, and safety. Random-effects models and leave-one-out analyses were used.

RESULTS

Four studies including 284 patients allocated to or undergoing adrenal artery embolization were included: outcome-specific sample sizes varied according to data availability. Adrenal artery embolization reduced 24-h systolic blood pressure by 15.31 mmHg and diastolic blood pressure by 10.49 mmHg. Plasma aldosterone decreased by 68.18 pg/mL, the aldosterone-to-renin ratio by 49.03, and serum potassium increased by 0.60 mmol/L. Serum cortisol did not significantly change. Pain and fever occurred in 82.41% (178/216) and 18.98% (41/216) of patients across three studies. Major adverse events occurred in 4.58% (13/284): four strokes (one fatal hemorrhagic, adjudicated unrelated), five hypertensive or severe-hypertension events, one myocardial infarction, one new-onset heart failure, one ventricular tachycardia, and one hypotensive event requiring vasopressors-only three within 1 month.

CONCLUSION

Adrenal artery embolization showed preliminary associations with improved blood pressure and biochemical outcomes without a significant change in serum cortisol. Evidence was predominantly uncontrolled, serious adverse events occurred, and superiority over optimized medical therapy was not established. Randomized trials with standardized techniques and long-term clinical outcomes are required.

LEVEL OF EVIDENCE: Level IV, Systematic Review/Meta-Analysis of predominantly single-arm studies.