Endocrine Abstracts

Background: Arterial Hypertension from the adrenal gland accounts for approximately 3% of diagnosed hypertension. The long-term surgical cure rate of patients with adrenal hypertension varies widely and causes of persistent hypertension are not completely established. The Aim of our study was to assess the prognosis of arterial hypertension from the adrenal gland and to determine its recovery predictive factors.

Methods: It was a retrospective, descriptive and analytical study including 67 patients with arterial hypertension from the adrenal gland (29 patients with primary hyperaldosteronism (group 1), 27 patients with pheochromocytoma (group 2) and 11 patients with Cushing’s syndrome (group 3)). Adrenalectomy was performed in all patients. Clinical and paraclinical data were determined before and after surgery. Hypertension recovery was defined by a blood pressure <140/90 mmHg without any antihypertensive drugs. Predictors of recovery were determined by calculating Odds Ratios.

Results: After adrenalectomy, a significant decrease in blood pressure was obtained in all three groups. The cure rate for hypertension was 52% in group 1, 37% in group 2, and 55% in group 3. Clinical and paraclinical profiles of patients recovered were comparable to those not cured in patients groups 1 and 3. In contrast, in group 2, cured patients had a lower prevalence of diabetes (P=0.026), a lower duration of hypertension (P=0.003), a lower LDL-cholesterol level (P=0.022), a higher creatinine level (P=0.020) and a lower prevalence of renal failure (P=0.049). For groups 1 and 3, we did not find any significant associations between recovery of hypertension and the most studied predictive factors in the literature, namely, young age, absence of family history of hypertension, duration of hypertension less than 5 years and the absence of overweight. However in group 2, the chances of curing hypertension were significantly multiplied by 10.1 in the absence of diabetes, by 8 in the absence of renal insufficiency and by 4.5 in the case of hypertension duration less than 5 years.

Conclusion: The persistence of hypertension after adrenalectomy could be the result of reduced ability to reverse pathological changes in the blood vessels or coexisting essential hypertension. Therefore, early screening and diagnosis, adequate hypertension control before surgery and management of associated comorbidities are mandatory in order to improve patients’ outcome.