Resolution of hypertension following adrenalectomy in patients with pheochromocytoma and Conn's syndrome: A comparative cohort study.

INTRODUCTION

There is limited literature comparing the resolution of hypertension after adrenalectomy for pheochromocytoma and Conn's syndrome endocrine hypertension. We assessed the rate of hypertension remission and factors predicting it among patients undergoing adrenalectomy.

METHODS

As part of an institutional review board-approved study, we retrieved data of patients who underwent adrenalectomy for localized pheochromocytoma or Conn's syndrome between 2020 and 2024 at our institution. Patients were contacted telephonically to assess the status of their hypertension.

RESULTS

Out of 61 eligible patients, 31 with pheochromocytoma and 16 with Conn's syndrome were included in this study. Patients with pheochromocytoma were younger (mean age: 30.8 years vs. 42.8 years), had a lower body mass index (20.7 kg/m2 vs. 28.4 kg/m2), had a lower preoperative duration of hypertension (median- 12 vs. 84 months), and had fewer antihypertensive medicines (median 2 vs. 4) than patients with Conn's syndrome. At discharge, 82.6% (n = 19/23) of pheochromocytoma patients achieved complete hypertension remission vs. 31.2% (n = 5/16) of Conn's syndrome patients (P < 0.01). At 1 year after surgery, remission was maintained in 85% (17/20) and 50% (7/14) of patients, respectively (P = 0.05). Older age (odds ratio [OR]: 1.08), worse preoperative disease burden (OR: 2.23), multifocal lesions on histopathology (OR: 12.27), and chronic kidney disease (OR: 15.43) were associated with persistence of hypertension postoperatively.

CONCLUSIONS

Adrenalectomy achieves quicker and more complete resolution of hypertension in patients with pheochromocytoma than in Conn's syndrome. Persistent hypertension is more likely in older patients with long standing, severe baseline hypertension, and other comorbidities.