Unilateral aldosterone-producing adrenal adenomas (APAs) are the potentially curable cause of 5% of all cases of hypertension. Their localisation (via adrenal vein sampling [AVS]) and removal (by laparoscopic adrenalectomy) require invasive procedures that are unattractive to patients. Molecular imaging-located, endoscopic ultrasound-guided trans-gastric radiofrequency ablation (EUS-RFA) is a potential novel, minimally invasive alternative to AVS and total adrenalectomy for the treatment of APAs in the left adrenal gland, which is very close to the stomach. We aimed to determine whether EUS-RFA can safely target a heterogeneous set of such tumours without damaging the rest of the adrenal gland or adjacent organs.

Some of the physiological changes that occur in pregnancy manifest in the liver. These alterations might exacerbate or improve some pre-existent liver diseases, while many conditions remain unaffected. Some hepatic manifestations during pregnancy are secondary to disorders unique to pregnancy. Due to improved management of chronic conditions and assisted conception methods, pregnancies in people with cirrhosis or after liver transplantation are increasingly common. With pregnancy also becoming more common in older people and with the rising prevalence of comorbidities, such as obesity, diabetes, and metabolic syndrome, hypertensive disorders of pregnancy and gestational diabetes are increasing in prevalance. Thus, a broad range of specialists might encounter liver abnormalities in pregnancy, necessitating an understanding of how the liver changes during pregnancy and the importance of multi-disciplinary input to mitigate maternal-fetal risks. From a global health perspective, pregnancy also offers a unique opportunity to influence disease management and initiate interventions that might influence the life course of pregnant people and their families. In this Review, we describe the challenges of diagnosing, risk stratifying, and managing liver disease in pregnancy, and explore factors that might affect future maternal health.