World Journal of Endocrine Surgery

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VOLUME 13 , ISSUE 1 ( January-April, 2021 ) > List of Articles

Original Article

Hypertension Cure and Reducing Pill Burden after Adrenalectomy for Endocrine Hypertension of Adrenal Origin: A Comparative Study from an Asian and UK Cohort

Ciaran Durand, Titus C Vasciuc, Chia H Tai, Raluca Orpean, Fiona Eatock, Mehak Mahipal, Tan W Boon, Kee Y Ngiam

Keywords : Adrenal, Adrenalectomy, Aldosterone-producing adenoma, Cushing's adenoma, Hypertension, Pheochromocytoma

Citation Information : Durand C, Vasciuc TC, Tai CH, Orpean R, Eatock F, Mahipal M, Boon TW, Ngiam KY. Hypertension Cure and Reducing Pill Burden after Adrenalectomy for Endocrine Hypertension of Adrenal Origin: A Comparative Study from an Asian and UK Cohort. World J Endoc Surg 2021; 13 (1):9-15.

DOI: 10.5005/jp-journals-10002-1314

License: CC BY-NC 4.0

Published Online: 20-11-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: The cure rate of endocrine hypertension following adrenalectomy is heterogeneous. Our aim of the study was to investigate the etiology and cure rate of endocrine hypertension between an Asian and UK cohort. Materials and methods: This is a retrospective study of patients who underwent adrenalectomy from two tertiary centers in Singapore (cohort I) and the UK (cohort II) for endocrine hypertension. Demographic, clinical details, blood pressure data, and cure rates of hypertension were collected and analyzed. Results: Cohort I included 115 patients (59F:56M), the mean age of 50.05 (SD 12.82), and cohort II had 128 patients (65F:63M), the mean age of 52.88 (SD 14.45) during the study period. There was a higher incidence of Conn's adenoma in cohort I, with predominantly left-sided tumors and grade I and II hypertension at presentation (p = 0.001). In contrast, cohort II had pheochromocytoma (PCC) as the most frequent diagnosis, right-sided tumors, and grade II and III hypertension (p = 0.001). Significant differences in the mean pre-op systolic and diastolic BP and choice of antihypertensive medications between the two cohorts were noted (p = 0.001). The hypertension cure rates were similar (70 vs 69%) between the two cohorts. In patients where no cure was achieved, adrenalectomy resulted in a decrease in the pill burden (decreased number of classes and standard dose) in both the cohorts (p = 0.03). The complications rates and overall mortality were comparable between the cohorts. Conclusion: The etiology of adrenal hypertension is different between the East and the West. Adrenalectomy cured hypertension in the majority of the patient and reduced pill burden where no cure for hypertension was achieved.

  1. Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996;275(20):1571–1576. DOI: 10.1001/jama.1996.03530440051036.
  2. Quinkler M, Lepenies J, Diederich S. Primary hyperaldosteronism. Exp Clin Endocrinol Diabetes 2002;110(6):263–271. DOI: 10.1055/s-2002-34588.
  3. Camelli S, Bobrie G, Postel-Vinay N, et al. LB01.11: Prevalence of secondary hypertension in young hypertensive adults. J Hypertens 2015;33(Suppl 1):e47. DOI: 10.1097/01.hjh.0000467473.21331.70.
  4. Funder JW. Primary aldosteronism as a public health issue. Lancet Diabetes Endocrinol 2016;4(12):972–973. DOI: 10.1016/s2213-8587(16)30272-8.
  5. Liao CH, Wu V, Jeff Chueh S, et al. Outcome of surgery for primary hyperaldosteronism. World J Surg 2012(5): Online ahead of print 10.1007/s00268-011-1370-6.
  6. Waldmann J, Maurer L, Holler J, et al. Outcome of surgery for primary hyperaldosteronism. World J Surg 2011;35(11):2422–2427. DOI: 10.1007/s00268-011-1221-5.
  7. Martucci VL, Pacak K. Pheochromocytoma and paraganglioma: diagnosis, genetics, management, and treatment. Curr Probl Cancer 2014;38(1):7–41. DOI: 10.1016/j.currproblcancer.2014.01.001.
  8. Nieman LK, Biller BM, Findling JW, et al. Treatment of Cushing's syndrome: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2015;100(8):2807–2831. DOI: 10.1210/jc.2015-1818.
  9. Gouli A, Kaltsas G, Tzonou A, et al. High prevalence of autonomous aldosterone secretion among patients with essential hypertension. Eur J Clin Investigat 2011;41(11):1227–1236. DOI: 10.1111/j.1365-2362.2011.02531.x.
  10. Calhoun DA, Nishizaka MK, Zaman MA, et al. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension 2002;40(6):892–896. DOI: 10.1161/01.hyp.0000040261.30455.b6.
  11. Baid S, Nieman LK. Glucocorticoid excess and hypertension. Curr Hypertens Rep 2004;6(6):493–499. DOI: 10.1007/s11906-004-0046-0.
  12. Magiakou MA, Mastorakos G, Oldfield EH, et al. Cushing's syndrome in children and adolescents--presentation, diagnosis, and therapy. N Eng J Med 1994;331(10):629–636. DOI: 10.1056/NEJM199409083311002.
  13. Stewart PM, Walker BR, Holder G, et al. 11 beta-hydroxysteroid dehydrogenase activity in Cushing's syndrome: explaining the mineralocorticoid excess state of the ectopic adrenocorticotropin syndrome. J Clin Endocrinol Metabol 1995;80(12):3617–3620. DOI: 10.1210/jcem.80.12.8530609.
  14. Bravo EL, Tagle R. Pheochromocytoma: state-of-the-art and future prospects. Endoc Rev 2003;24(4):539–553. DOI: 10.1210/er.2002-0013.
  15. Sharma ST, Nieman LK. Cushing's syndrome: all variants, detection, and treatment. Endocrinol Metabol Clin 2011;40(2):379–391. DOI: 10.1016/j.ecl.2011.01.006.
  16. Zhou Y, Zhang M, Ke S, et al. Hypertension outcomes of adrenalectomy in patients with primary aldosteronism: a systematic review and meta-analysis. BMC Endocri Disord 2017;17(1):61–69. DOI: 10.1186/s12902-017-0209-z.
  17. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J 2018;39(33):3021–3104. DOI: 10.1093/eurheartj/ehy339.
  18. Loh K-C, Koay ES, Khaw M-C, et al. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore1. J Clin Endocrinol Metabol 2000;85(8):2854–2859. DOI: 10.1210/jcem.85.8.6752.
  19. Mulatero P, Stowasser M, Loh K-C, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metabol 2004;89(3):1045–1050. DOI: 10.1210/jc.2003-031337.
  20. Omura M, Saito J, Yamaguchi K, et al. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypert Res 2004;27(3):193–202. DOI: 10.1291/hypres.27.193.
  21. Käyser SC, Deinum J, de Grauw WJ, et al. Prevalence of primary aldosteronism in primary care: a cross-sectional study. Br J Gen Pract 2018;68(667):e114–e122. DOI: 10.3399/bjgp18X694589.
  22. Fogari R, Preti P, Zoppi A, et al. Prevalence of primary aldosteronism among unselected hypertensive patients: a prospective study based on the use of an aldosterone/renin ratio above 25 as a screening test. Hypertens Res 2007;30(2):111–117. DOI: 10.1291/hypres.30.111.
  23. Westerdahl C, Bergenfelz A, Isaksson A, et al. Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area. Scand J Prim Health Care 2011;29(1):57–62. DOI: 10.3109/02813432.2011.554015.
  24. WHO. Global Health Expenditure Database. WHO; 2017.
  25. Puar T, Mok Y, Debajyoti R, et al. Secondary hypertension in adults. Singapore Med J 2016;57(5):228–232. DOI: 10.11622/smedj.2016087.
  26. Arlt W. A detour guide to the endocrine society clinical practice guideline on case detection, diagnosis and treatment of patients with primary aldosteronism. Eur J Endocrinol 2010;162(3):435–438. DOI: 10.1530/eje-09-0869.
  27. Berends AMA, Buitenwerf E, de Krijger RR, et al. Incidence of pheochromocytoma and sympathetic paraganglioma in the Netherlands: a nationwide study and systematic review. Eur J Intern Med 2018;51:68–73. DOI: 10.1016/j.ejim.2018.01.015.
  28. Lenders JW, Eisenhofer G, Mannelli M, et al. Phaeochromocytoma. Lancet 2005;366(9486):665–675. DOI: 10.1016/S0140-6736(05)67139-5.
  29. Kim JH, Moon H, Noh J, et al. Epidemiology and prognosis of pheochromocytoma/paraganglioma in Korea: a nationwide study based on the national health insurance service. Endocri Metab (Seoul) 2020;35(1):157–164. DOI: 10.3803/enm.2020.35.1.157.
  30. Parikh PP, Rubio GA, Farra JC, et al. Nationwide review of hormonally active adrenal tumors highlights high morbidity in pheochromocytoma. J Surg Res 2017;215:204–210. DOI: 10.1016/j.jss.2017.04.011.
  31. Chadwick D. The British Association of Endocrine and Thyroid Surgeons. Fifth National Audit Report 2017. April ed., Oxford: Dendrite Clinical Systems Ltd; 2017. pp. 150–154.
  32. Sriphrapradang C, Choopun K, Tunteeratum A, et al. Genotype-phenotype correlation in patients with germline mutations of VHL, RET, SDHB, and SDHD Genes: Thai experience. Clin Med Insights Endocrinol Diabetes 2017;10:1179551417705122–1179551417705122. DOI: 10.1177/1179551417705122.
  33. Khadilkar K, Sarathi V, Kasaliwal R, et al. Predictors of malignancy in patients with pheochromocytomas/paragangliomas: Asian Indian experience. Endocr Connect 2016;5(6):89–97. DOI: 10.1530/EC-16-0086.
  34. Chew WHW, Courtney E, Lim KH, et al. Clinical management of pheochromocytoma and paraganglioma in Singapore: missed opportunities for genetic testing. Molecul Genet Geno Med 2017;5(5):602–607. DOI: 10.1002/mgg3.313.
  35. Pang TC, Bambach C, Monaghan JC, et al. Outcomes of laparoscopic adrenalectomy for hyperladosteronism. ANZ J Surg 2007;77(9):768–773. DOI: 10.1111/j.1445-2197.2007.04225.x.
  36. Worth PJ, Kunio NR, Siegfried I, et al. Characteristics predicting clinical improvement and cure following laparoscopic adrenalectomy for primary aldosteronism in a large cohort. Am J Surg 2015;210(4):702–709. DOI: 10.1016/j.amjsurg.2015.05.033.
  37. Trésallet C, Salepçioglu H, Godiris-Petit G, et al. Clinical outcome after laparoscopic adrenalectomy for primary hyperaldosteronism: the role of pathology. Surgery 2010;148(1):129–134. DOI: 10.1016/j.surg.2009.11.020.
  38. Hannon M, Sze W, Carpenter R, et al. Clinical outcomes following unilateral adrenalectomy in patients with primary aldosteronism. QJM 2017;110(5):277. DOI: 10.1093/qjmed/hcw194.
  39. Burrello J, Burrello A, Stowasser M, et al. The primary aldosteronism surgical outcome score for the prediction of clinical outcomes after adrenalectomy for unilateral primary aldosteronism. Ann Surg 2020;272(6):1125–1132. DOI: 10.1097/SLA.0000000000003200.
  40. Katabami T, Fukuda H, Tsukiyama H, et al. Clinical and biochemical outcomes after adrenalectomy and medical treatment in patients with unilateral primary aldosteronism. J Hypertens 2019;37(7):1513–1520. DOI: 10.1097/HJH.0000000000002070.
  41. Brunt LM, Moley JF, Doherty GM, et al. Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery 2001;130(4):629–635. DOI: 10.1067/msy.2001.116920.
  42. Xie L-F, Ouyang J-Z, Wang A-P, et al. Gene expression profile of persistent postoperative hypertension patients with aldosterone-producing adenomas. Chin Med J (Engl) 2015;128(12):1618–1626.
  43. Sapienza P, Cavallaro A. Persistent hypertension after removal of adrenal tumours. Eur J Surg 1999;165(3):187–192. DOI: 10.1080/110241599750007027.
  44. Lumachi F, Ermani M, Basso SMM, et al. Long-term results of adrenalectomy in patients with aldosterone-producing adenomas: multivariate analysis of factors affecting unresolved hypertension and review of the literature. Am Surg 2005;71(10):864. DOI: 10.1177/000313480507101015.
  45. Citton M, Viel G, Rossi GP, et al. Outcome of surgical treatment of primary aldosteronism. Langenbeck's Archi Surg 2015;400(3):325–331. DOI: 10.1007/s00423-014-1269-4.
  46. Sawka AM, Young WF, Thompson GB, et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Int Med 2001;135(4):258. DOI: 10.7326/0003-4819-135-4-200108210-00010.
  47. Proye CAG, Mulliez EAR, Carnaille BML, et al. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surgery 1998;124(6):1128–1133. DOI: 10.1067/msy.1998.93108.
  48. Wolf-Maier K, Cooper RS, Kramer H, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 2004;43(1):10–17. DOI: 10.1161/01.Hyp.0000103630.72812.10.
  49. Rossi GP, Bolognesi M, Rizzoni D, et al. Vascular remodeling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension 2008;51(5):1366–1371. DOI: 10.1161/hypertensionaha.108.111369.
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