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

Autor: Clemente-Gutiérrez U; 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., Pérez-Soto RH; 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., Hernández-Acevedo JD; 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., Iñiguez-Ariza NM; 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., Casanueva-Pérez E; 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., Pantoja-Millán JP; 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., Sierra-Salazar M; 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., Herrera MF; 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., Velázquez-Fernández D; 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. velazquezmerlin2004@yahoo.com.mx.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2021 Sep; Vol. 406 (6), pp. 2027-2035. Date of Electronic Publication: 2021 Jun 23.
DOI: 10.1007/s00423-021-02245-2
Abstrakt: 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.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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