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Hypertension: can hypertension now be cured by surgery?


Conn adenoma: high blood pressure can sometimes be cured by surgery

Around 20 to 30 million people in Germany suffer from high blood pressure. In a certain percentage of those affected, health experts suspect a hormonal cause. Surgery could permanently cure many of these patients.

Risk factor for dangerous cardiovascular diseases

Especially in the western world, high blood pressure (hypertension) is a common disease. According to the German Hypertension League, around 20 to 30 million people are affected in this country. Too high blood pressure is a significant risk factor for dangerous cardiovascular diseases. To lower blood pressure, it is often enough to eat healthier and exercise more. But in some patients, hypertension must be treated with medication. And surgery can help some people, explains the German Society for Endocrinology in the run-up to the 18th International Adrenal Gland Conference.

Hormonal causes

In addition to being overweight or obese, risk factors for high blood pressure include lack of exercise, an unhealthy, overly salty diet, tobacco and increased alcohol consumption and stress.

But as the working group of the scientific medical societies reports in a message published by the Science Information Service (IDW), high blood pressure does not always have to do with lifestyle.

Experts suspect a hormonal cause in four to twelve percent of high-pressure patients. This includes the Conn adenoma - a tumor in the bark of the adrenal glands that produces excessive aldosterone. This hormone regulates the body's saline and fluid content.

"If too much aldosterone is released, the salinity in the body increases and hypertension occurs," explains Professor Dr. 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 Dr. Stefanie Hahner from the Würzburg University Hospital.

But this intervention - the so-called adrenalectomy - rarely occurs, as Hahner explains. The Conn syndrome is often not recognized as the cause of the high blood pressure, according to the expert.

To make an accurate diagnosis, the blood from the adrenal veins has to be extensively examined with a catheter - only a few centers in Germany specialize in this.

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

"The CT only shows us whether there is a tumor in the adrenal gland, but it does not provide any evidence that the tumor also forms aldosterone," says Hahner.

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

Often no cause is found

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

Dr. Andreas Schirbel, radiochemist at the PET center of the University Hospital in 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 adrenal glands has to be removed.

In the vast majority of hypertensive patients, doctors find no cause that could be remedied by treatment. These people often have to take blood pressure lowering medications for life to lower their risk of stroke, heart attack or other circulatory diseases.

But lifestyle changes such as more exercise, healthy eating and giving up smoking also help. The challenge remains to identify those patients for whom the high pressure has hormonal causes.

"We hope that our PET tracers will be introduced in the clinics in the next few years and will help to ensure that Conn's syndrome is diagnosed and treated more frequently than before," says Schirbel. (ad)

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Video: Simple Steps for Controlling Hypertension (August 2020).