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

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Abstract

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 < 0.0001), and PHEO (p < 0.0001).

Conclusion

SH remission rates are 57–100% after adrenalectomy. Several prognostic factors could be used to predict SH control. Adrenalectomy provides good clinical outcome and must be considered a treatment option in all surgical candidates.

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Authors and Affiliations

  1. Endocrine Surgery and Advanced Laparoscopy Service, Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Dominguez Sección XVI, Mexico City, 14080, México

    Uriel Clemente-Gutiérrez, Rafael H. Pérez-Soto, Juan D. Hernández-Acevedo, Enrique Casanueva-Pérez, Juan Pablo Pantoja-Millán, Mauricio Sierra-Salazar, Miguel F. Herrera & David Velázquez-Fernández

  2. Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Dominguez Sección XVI, Mexico City, 14080, México

    Nicole M. Iñiguez-Ariza

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  1. Uriel Clemente-Gutiérrez
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  2. Rafael H. Pérez-Soto
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  9. David Velázquez-Fernández
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Contributions

Study conception and design: Clemente-Gutierrez U, Herrera MF, and Velazquez-Fernandez D. Acquisition of data: Clemente-Gutierrez U, Perez Soto RH, Hernandez-Acevedo JD, and Casanueva-Perez E. Analysis and interpretation of data: Clemente-Gutierrez U., Herrera MF, and Velazquez-Fernandez D. Drafting of manuscript: Clemente-Gutierrez U., Herrera MF, and Velazquez-Fernandez D. Critical revision of manuscript: Clemente-Gutierrez U., Iniguez-Ariza N, Pantoja-Millan J, Sierra-Salazar M, Herrera MF, and Velazquez-Fernandez D.

Corresponding author

Correspondence to David Velázquez-Fernández.

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This protocol was approved by the institutional bioethics committee for human research (# 3190) of our institution.

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Due to the retrospective nature of this research, the institutional bioethics committee for human research exempted the need for informed consent.

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The authors declare no competing interests.

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Clemente-Gutiérrez, U., Pérez-Soto, R.H., Hernández-Acevedo, J.D. et al. Endocrine hypertension secondary to adrenal tumors: clinical course and predictive factors of clinical remission. Langenbecks Arch Surg 406, 2027–2035 (2021). https://doi.org/10.1007/s00423-021-02245-2

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