Surgical treatment in hypertension associated with adrenal diseases

Despite the recent advancesin diagnosis and surgical treatment of hormonally active adrenal tumors (GAAT), the awareness of medical practitioners about the disease remains insufficient. The results of examination and treatment of 758 GAAT patients prove that long existing symptomatic (secondary) arterial hypertension (SHTN) is malignant characterized by the development of vascular complications involving cardiac and/or cerebral arteries, and drug-resistance and requires pre-surgery correction of metabolic and endocrine disorders. In GAAT, adrenalectomy is the main method of SHTN treatment. The reasons for maintaining or recurrence of arterial hypertension (HTN) after surgery in 35,7% of patients are not associated with surgery itself, but are due to the long duration of high blood pressure due to a 5,37 ± 3,30 years before the manifestation of the tumor in adult patients (older 44,75 ± 3,89 s), and co-existent endocrine, metabolic and cardiovascular disorders. The predominance of the pressor hormones over depressor ones leads to the cardiovascular remodeling, causes the development of left ventricular diastolic dysfunction due to impaired relaxation and the increased role of atrial systole in its filling. If these factors are identified, the selection and follow-up of the patients after surgery, and the choice of antihypertensive therapy are required. Early diagnosis of GAAT, adequate preoperative drug therapy, and implementation of timely surgical treatment contribute to the elimination of adrenal-related SHTN, provide good treatment results and better quality of life in GAAT patients. 

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