Persistent hypertension after successful adrenal operation

Up to 80% of patients with adrenocortical tumors comprising Conn's or Cushing's syndrome and patients with pheochromocytomas suffer from hypertension. Its implications in cardiovascular disease and its impact on quality of life make it the most important aim in therapeutic efforts. The aim of our study was to assess the long-term results in postoperative blood pressure after adrenalectomy and to evaluate potential risk factors for persistent hypertension.

Forty four patients with adrenal hypertension operated on between April 1986 and April 1991 underwent follow-up consisting of exact history, hormonal analysis, and adrenal imaging.

Forty three patients were reexamined, which showed 11 patients (26%) with hypertension at dismissal from hospital and 17 patients (40%) with hypertension after a median of 2 years. Except for two recurrent tumors in adrenocortical carcinoma all patients were surgically cured. Antihypertensive medication could be reduced in 13 of 17 patients with persistent hypertension. Persistent hypertension did not correlate with the degree of preoperative blood pressure elevation, age, and gender, but it did correlate strongly with history of hypertension. Patients with normal blood pressure level after operation had a mean history of 5.7 years versus 11.5 years in patients with persistent hypertension (p < 0.03).

The success of surgical treatment for adrenal hypertension strongly depends on early diagnosis and surgical intervention.