Evolution of a surgical service for adrenal pathology and impact of surgical intervention on resistant hypertension
Background: An insight into the impact of adrenalectomy on the management of hypertension is helpful in counselling patients when deciding on surgical intervention.
Methods: We prospectively studied the outcome after surgical intervention for proven functional adrenal adenomas, particularly in regard to post-operative requirement of antihypertensive medications.
Results: All patients were prospectively logged onto a comprehensive database, which allowed subsequent long-term follow-up. Account was taken of morbidity encountered.
Conclusions: A total of 77 patients (78 adrenal glands) underwent adrenal surgery between 1995 and 2013. In all, 44 patients (44/77) had proven functional adenomas, phaeochromocytoma (15/44, 34 %), Conn’s (25/44, 56 %), Cushing’s 4 (4/44, 10 %). A minimum follow-up of 12 months revealed all patients to have a reduction in their disease-specific medication with 75 % Cushing’s, 72 % Conn’s and 60 % phaeochromocytoma patients medicine free. Despite the potential for functioning adenomas to produce irreversible change, the intervention of adrenalectomy appears to be beneficial in the vast majority of patients with at least half independent of antihypertensive medication. A reduction in morbidity was demonstrated as experience increased.