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Could surgery cure hypertension?

Northwest Medical Center January 22, 2013

By Alfredo Arango
Medical Writer

Long term sustained hypertension can have an adverse effect on arterial, cardiac and renal functions leading to a potentially life threatening condition. A possible cause of hypertension could be the presence of a tumor in the suprarenal glands. These glands, which sit above the kidneys, produce hormones that aid the body to react during times of stress and help to regulate other essential functions including metabolism, immune system and glucose usage.

Surgery can be an answer for patients with excessive high blood pressure caused by a suprarenal gland tumor. The good news is that this surgery, which was traditionally performed as an open procedure with a slow and painful recovery period, can now be accomplished with less invasive methods that reduce patient distress.

“In prior years, suprarenal gland removal (adrenalectomy) required an open surgery, but now, it can be performed as a laparoscopic procedure. This procedure, which can last one or more hours depending upon the complexity of each individual case, only requires four small incisions. In the absence of other medical conditions, the patient can usually return home the next day,” according to Dr. Eric Kleinstein, general surgeon at Northwest Medical Center, in Margate, Florida. An expert in this field, he adds that “in addition to a shorter hospital stay, benefits include faster recovery, lesser need for pain medication and a lower complication rate.”

There are several types of tumors that can appear in the suprarenal glands: malignant adrenal tumors, such as pheochromocytomas; benign adrenal tumors; enlargement or abnormalities of the adrenal gland, resulting in symptoms and complications due to excess hormone production, such as Cushing’s Syndrome; a large non-functioning adrenal mass; an adrenal mass that cannot be biopsied with a needle biopsy.

Out of all these anomalies, the most common ones are precisely the tumors that cause substance overproduction, which in turn, raises blood pressure levels. Typically, the problem is present in only one of the glands. If one gland is removed, the other one replaces it. If both glands are affected, it is possible to remove both of them (bilateral surgery), but, the patient will require lifelong hormone supplementation.

“The primary issue is that suprarenal tumor removal can cure those patients who suffer with high blood pressure. Of course, not all cases of hypertension are caused by this condition nor can they be treated with this method,” asserts Dr. Kleinstein while adding that this is a somewhat rare condition; for this reason, few patients are able to control blood pressure levels this way and a small number of surgeons perform the procedure.

The surgeon further clarifies that, in some cases, the minimally invasive technique is not feasible and the patient must undergo an open surgery. Many physicians prefer to perform open surgeries with cancerous tumors to facilitate a more thorough exploration and block removal of the affected area. According to the Department of Surgery of the University of Southern California “at this time, the only indication for open surgery would be in patients with cancer of the adrenal glands or patients that have an abnormal and highly enlarged adrenal gland that is greater than 10cm (6”). For all other patients, a laparoscopic adrenalectomy is preferred.

After comparing laparoscopic and open adrenalectomy, a study by the Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, north of Taiwan, determined that both surgical procedures required a comparable amount of time and shared a similar rate of complications; however, after a laparoscopic procedure, patients had less postoperative pain and bleeding, which in turn, decreased the need for pain medication, allowing a faster return to oral feeding and a shorter hospitalization period.

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