Endocrine Abstracts

Introduction: Endocrine hypertension is the most common cause of secondary hypertension affecting nearly 3% of the population. Adrenal etiologies play a significant role in these cases. An adrenal incidentaloma is an asymptomatic adrenal tumor, at least one cm in diameter, discovered incidentally during a medical imaging examination. It requires an investigation into its secretory or malignant nature leading to the development of arterial hypertension.

Materials and Methods : This is a retrospective descriptive study focusing on patient records where an adrenal incidentaloma was discovered during hospitalization for hypertension. We documented clinical and biological presentation, etiological profile as well as diagnostic and therapeutic methods.

Results: Our series included 22 patients:2males and 20 females, aged between 29 and 76 years, with a mean age of 52 years. Family history revealed familial hypertension in 18 patients (81.8%), 3 cases of early stroke and 1 case of myocardial infarction. At the time of diagnosis, 6 patients had type 2 diabetes(average duration of 4 months) and a standard deviation (SD) of 3 months. Only one patient was a smoker, and one had dyslipidemia treated with statin. The discovery of hypertension occurred with headache in 7 patients (31.8%), Menard triad (headache, palpitations and sweats) in 5 patients (22.7%), tinnitus in 2 patients (9.1%)and was incidental in 8 patients (36.4%). Among these, 4 cases had refractory hypertension (18.2%) and 2 cases had malignant hypertension (9.1%). No patient experienced complications. The mean systolic blood pressure was 16.1mmHg and the mean diastolic blood pressure was 9.1mmHg. The average weight of the population was 79.8 kg, the average height of 159.19 cm, the average BMI of 31.13 kg/m²; and the average waist circumference of 105 cm with a SD of 26.6 cm. Biologically, the average blood glucose was 6.57 mmol/l and the average serum potassium was 3.8 mmol/l with a SD of 0.57 mmol/l. Ten patients had a confirmed hypokalemia. A CT scan focused on the adrenals revealed an incidentaloma with an average size of 21.5 mm and a standard deviation of19.21mm. The etiological diagnosis included pheochromocytoma in 7 patients(31.8%), clinically and biologically confirmed hypercortisolism in 9 cases (27.3%)of which6 were adenomas, 1 corticosurrenaloma and 2 bilateral adrenal hyperplasia. There were also 4 cases of primary hyperaldosteronism (18.2%). Two patients did not have hormonal secretion and thus had essential hypertension. For etiological treatment, 18 patients underwent unilateral adrenalectomy for endocrine hypertension (81.8%), while 4 patients received medical treatment(18.2%). Medical treatment for hypertension included ACE inhibitors in 5 patients (22.7%) calcium channel blockers in 4 patients (18.2%), angiotensin receptor antagonists in 2 patients (9.1%), and 1 patient received thiazide diuretic alone. Combination therapy was used in 6 patients, and triple therapy in 4 patients.

Conclusion: Adrenal hypertension is a treatable cause of secondary hypertension. The clinical signs resulting from hyperadrenergic activity, hypercortisolism, or hyperaldosteronism are not specific, but they disappear after surgery, which remains the only curative treatment.