Endocrine hypertension secondary to adrenal tumors: clinical course and predictive factors of clinical remission

Purpose Endocrinopathies constitute ~ 10% of secondary hypertension (SH) etiologies. Primary aldosteronism, pheochromocytoma (PHEO), and Cushing’s syndrome are common causes. Early identification and treatment result in resolution/improvement of SH. The aim of this study was to characterize the clin...

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Published in:Langenbeck's archives of surgery 2021-09, Vol.406 (6), p.2027-2035
Main Authors: Clemente-Gutiérrez, Uriel, Pérez-Soto, Rafael H., Hernández-Acevedo, Juan D., Iñiguez-Ariza, Nicole M., Casanueva-Pérez, Enrique, Pantoja-Millán, Juan Pablo, Sierra-Salazar, Mauricio, Herrera, Miguel F., Velázquez-Fernández, David
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
General Surgery
Medicine
Medicine & Public Health
Original Article
Thoracic Surgery
Traumatic Surgery
Vascular Surgery
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Summary:Purpose Endocrinopathies constitute ~ 10% of secondary hypertension (SH) etiologies. Primary aldosteronism, pheochromocytoma (PHEO), and Cushing’s syndrome are common causes. Early identification and treatment result in resolution/improvement of SH. The aim of this study was to characterize the clinical course, outcomes, and remission-associated prognostic factors of SH related to adrenal tumors. Methods Retrospective cohort study including patients with SH who underwent adrenalectomy from 2000 to 2019. Postoperative outcomes were analyzed. Remission was defined as normalization of blood pressure without drug use. Results Eighty-three patients with SH were included. Mean ± SD age was 38.8 ± 14.2 years and 75.9% were women. Diagnosis was PHEO in 35 patients (42.2%), aldosteronoma (APA) in 28 (33.7%), cortisol producing adenoma (CPA) in 16 (19.3%), and ACTH-dependent Cushing’s in 4 (4.8%). Laparoscopic adrenalectomy was performed in 81 (97.6%) patients. Mean ± SD follow-up was 57.4 ± 49.6 months (range 1–232). Surgical morbidity occurred in 7.2% of patients and there was no mortality. Remission of SH occurred in 61(73.5%): 100% of ACTH-dependent Cushing’s, 85.7% of PHEO, 68.8% of CPA, and 57.1% of APA. Biochemical phenotype and the combination of larger tumor size, number of antihypertensive drugs, male gender, older age, obesity, and preoperative SH for more than 5 years were associated with less likely clinical remission in patients with APA ( p  = 0.004), CPA ( p  
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-021-02245-2