Hypertension Can hypertension now be cured by surgery?

Conn Adenoma: Hypertension can sometimes be cured by surgery

In Germany, about 20 to 30 million people suffer from hypertension. In a certain percentage of those affected health experts suspect a hormonal cause. Many of these patients could be permanently cured by surgery.

Risk factor for dangerous cardiovascular diseases

Especially in the western world, high blood pressure (hypertension) is a widespread disease. In Germany, about 20 to 30 million people are affected, according to the German High Pressure League. High blood pressure is a major risk factor for dangerous cardiovascular disease. To lower blood pressure, it is often enough to eat healthier and exercise more. But in some patients hypertension needs to be treated with medication. Surgery may also be helpful in some cases, explains the German Society for Endocrinology in the run-up to the 18th International Adrenal Conference.

Hypertension can often be treated by a healthier lifestyle. But sometimes drugs are needed. And in some cases, hypertension can be cured by surgery. (Image: think4photop / fotolia.com)

Hormonal causes

Risk factors for high blood pressure include overweight or obesity, lack of exercise, an unhealthy, salty diet, tobacco and increased alcohol consumption and stress.

However, as reported by the Association of the Scientific Medical Societies e.V. in a communication published by the Information Service Science (idw), hypertension does not always have to do with lifestyle.

In four to twelve percent of high-pressure patients, experts suspect a hormonal cause. These include Conn adenoma - a tumor in the adrenal cortex that produces excessive aldosterone. This hormone regulates the saline and fluid content of the body.

"If too much aldosterone is released, the salt content in the body rises and it comes to high blood pressure," explains Professor. med. Martin Fassnacht, Head of Endocrinology and Diabetology at the University Hospital Würzburg.

Conn adenoma can be removed by surgery

According to the information, a Conn adenoma can be removed by surgery. "Many patients are then cured of high blood pressure," explains Professor. med. Stefanie Hahner from the University Hospital Würzburg.

But this procedure - the so-called adrenalectomy - is rare, as Hahner explains. Often Conn syndrome is not recognized as the cause of hypertension, the expert said.

For a precise diagnosis, the blood from the adrenal veins must be laboriously examined with a catheter - only a few centers in Germany are specialized in this.

A simpler alternative is computed tomography (CT). However, an international study shows that CT is less reliable than selective blood sampling.

"CT only shows us if there is a tumor in the adrenal gland, but it does not give any indication that the tumor also produces aldosterone," says Hahner.

The study found that adrenalectomy after a CT scan is much less likely to normalize hormone levels.

Often no cause is found

An investigation that simultaneously represents a tumor and could indicate its hormone production is positron emission tomography (PET). The PET measures the radiation emitted by a slightly radioactive substance, called a tracer, that is previously injected into the patient via a vein.

Dr. Andreas Schirbel, radiochemist at the PET Center of the University Hospital Würzburg and co-workers have developed several tracers in recent years that bind to an enzyme in the tumor cells and thereby indicate whether an adenoma is present and which of the two adrenals must be removed.

In the vast majority of hypertensive patients, the doctors find no cause that could be turned off by treatment. These people often need to take blood pressure-lowering medicines for life to reduce their risk of stroke, heart attack or other circulatory disease.

But also lifestyle changes such as more exercise, a healthy diet and abstaining from smoking help. The challenge remains to identify those patients with high blood pressure hormonal causes.

"We hope that our PET tracers will be launched in the clinics over the next few years and help make Conn syndrome more common than previously diagnosed and treated," says Schirbel. (Ad)