Clinical course and management of adrenal endocrine hypertension: A single-center experience

Objectives. Endocrine etiologies of secondary hypertension (HTN) are frequent and increasingly diagnosed according to the learned societies. Adrenal causes as primary aldosteronism (PA), pheochromocytomas (PHEO), and ACTH-independent Cushing’s syndrome (CS) are widely described separately regarding their clinical, biochemical, and morphological aspects and only a few studies have developed the particular aspect of associated HTN. For this reason, we conducted a retrospective observational descriptive study at a tertiary referral center.

Subjects. Fifty-five subjects were included (PA: 52.8%, PHEO: 29.1%, and CS: 18.1%). We found a slight female preponderance (60%). The average age of participants was 47.0±14.9 years. First-degree family history of HTN was described in up to two thirds of cases. Regarding HTN characteristics, subjects with PA presented significantly younger age at diagnosis and had more severe and resistant profile and required higher number of antihypertensive drugs. HTN-mediated organ damage (HMOD) was mainly cardiovascular and ocular. Patients with PHEO were significantly older at diagnosis and had more severe and paroxysmal HTN. Patients with CS had less severe HTN and less HMOD. Specific treatments were indicated in all cases aiming complete remission of HTN. Subjects with PA were treated medically with mineralocorticoid receptor antagonists in 72.4% of cases and HTN remission was achieved in only 21.8% after surgical treatment. All subjects with PHEO were operated with adrenalectomy and the remission was observed in 37.5% of cases, while patients with CS were surgically managed in 50% of cases with 40% of HTN remission.

Conclusions. Diagnosis and management of adrenal endocrine HTN diseases are challenging for healthcare professionals and early screening is crucial for prevention of cardiovascular morbidity.