Current diagnostic and therapeutic aspects of symptomatic arterial hypertension of adrenal genesis

Abstract

Aim. To analyse the experience in diagnosis and treatment of arterial hypertension (AH) of adrenal genesis. Material and methods. A total of 243 patients with adrenal AH (mean age 46.3 ± 3.2 years) were examined. 134 of them had endogenic adrenohypercorticism (EAH), 62 - primary hyperaldosteronism (PHA), 47 - chromaffin tissue tumors (CTT). Diurnal urinary excretion of adrenal hormones (epinephrine, norepinephrine, aldosteron, hydrocortisone) and peripheral blood hormones (aldosteron, renin, hydrocortisone, ACTH) were measured. Topic diagnosis was made with ultrasound, computed tomography, MR-imaging, angiography, adrenal venous sampling and l2JI-MIBG scintigraphy. Results. Adrenalectomy was made in 224 patients (predominantly with tumor lesions). 19 patients (idiopathic hyperaldosteronism, advanced adrenocortical carcinoma) were treated conservatively (calcium antagonists, ACE inhibitors, ATI-receptor blockers, spironolacton). Good results of the surgical treatment were achieved in 60% patients with aldosterone-producing adenoma and adrenal Cushing's syndrome as well as in 80.5% patients with pheochromocytoma. Long-term outcomes depend on hypertension duration, histologic type of the tumor, age and family hypertension history (risk of essential hypertension). Conclusion. Hypertension of adrenal origin occurs more frequently than it was supposed previously. Its late diagnosis may be due to lack of typical signs and symptoms, insufficient application of novel diagnostic techniques and poor alertness of physicians, ft is recommended to include tests for adrenal hormones in urine and blood and ultrasound investigation of the adrenals in a complex of primary examination of patients with severe refractory hypertension.

Keywords

• arterial hypertension
• primary hyperaldosteronism
• kenko-cushing syndrome
• pheochromocytoma
• diagnosis
• treatment