Hypertension is not always cured after unilateral adrenalectomy in patients with endocrine secondary hypertension

Background It is commonly accepted that adrenalectomy cures hypertension in secondary endocrine hypertensions. The purpose of this study was to evaluate the percentage of cure of hypertension after adrenal surgery in three causes of endocrine hypertension: Conn's adenoma, pheochromocytoma and cortisolic adenoma. Methods Patients with hypertension with a radiological and hormonal check-up confirming the diagnosis of endocrine hypertension by Conn's adenoma (55 cases), pheochromocytoma (39 cases) or cortisolic adenoma (15 cases) have had unilateral adrenal surgery. Before the surgery, patients were treated with anti-anhypertensive drugs specific to each cause allowing the control of blood pressure in home blood pressure monitoring in 89% of subjects. In the 3 months following surgery, blood pressure was reassessed by home monitoring after stopping antihypertensive drugs. Results Healing of hypertension was observed in 69% of pheochromocytomas, 60% of Conn's adenomas and 40% of cortisolic adenomas. In subjects with Conn's adenoma the healing characteristics are: age less than 40 years, female sex, normalization of blood pressure before surgery with spironolactone treatment and normality of the opposite adrenal gland on CT. For pheochromocytoma, parameters linked with hypertension healing were normalization of blood pressure before surgery with specific medical treatment and age less than 40 years. For cortisol adenoma, young age at surgery is also linked with healing hypertension. Conclusion This work indicates that in secondary hypertensions, adrenal surgery does not achieve a cure in all patients in the months following surgery. The characteristics that predict the cure of hypertension are the effectiveness of medical treatment before surgery, and a patient's age of less than 40 years.