Factors Influencing the Outcomes of Operations for Adrenal Hypertention

Cho, Min Young; Bae, Jeoung Won; Suh, Sung Ock; Lee, Jae Bok; Koo, Bum Hwan

Abstract

This study was carried out to evaluate the factors influencing the outcome of an operation for adrenal hypertension. 35 patients with adrenal hypertension who were operated on between Jan. 1989 and Dec. 1996 at the Department of surgery, Korea University Hospital, underwent an adrenalectomy for pheochromocytoma, Cushing's syndrome and primary aldosteronism. Out of 20 clinicopathologic factors, only 3 were showen through univariate analysis to be associated with postoperative persistent hypertension. Fifteen of the 16 patients with pheochromocytoma (93.8%), 4 of the 7 patients with Cushing's syndrome (57.8%), and 5 of the 12 patients with primary aldosteronism became normotensive following surgery. Persistent hypertension correlated with a kind of adrenal hypertension, especially Cushing's syndrome or primary aldosteronism (p=0.012). In primary aldosteronism, none of the patients with fundoscopic arterial grade of more than III were in the complete response group but 5 of the 7 patients in the incomplete response group (p=0.004). For primary aldosteronism the mean serum renin level for the complete response group was 0.058+/-0.025 ng/ml/hr and that of incomplete response group was 0.51+/-0.87 ng/ml/hr (p=0.03). This study suggests that or adrenalectomy for hypertension with Cushing's syndrome or primary aldosteronism results in a more unfavorable outcome than one for hypertension with pheochromocytoma. The presence of fundoscopic arterial grade of more than III or a depressed serum renin level in primary aldosteronism was a cautious predictor of persistent hypertension after the adrenalectomy.