Surgery Treats Hypertension in Patients With Adrenal Tumours
In patients with unilateral adrenal incidentalomas and mild autonomous cortisol secretion (MACS), adrenalectomy was well tolerated and enabled a reduction or cessation of hypertensive treatment while maintaining blood pressure within normal ranges.
METHODOLOGY:
Researchers conducted this clinical trial in university hospitals across Europe to assess the effect of adrenalectomy on hypertension in patients with unilateral benign adrenal incidentalomas and MACS.
They enrolled patients with a unilateral adrenal adenoma (≥ 2 cm) and MACS, in whom hypertension was confirmed through multiple home blood pressure measurements; a standardised stepped-care antihypertensive treatment was implemented until the measurements normalised to less than 135/85 mm Hg.
A total of 52 patients (median age, 63.3 years; 69% women) were then randomly assigned to either undergo adrenalectomy or receive conservative management and were followed up for 13 months; after randomisation, antihypertensive medications were adjusted on the basis of the stepped-care treatment approach.
The primary outcome was the proportion of patients in each group who reduced their antihypertensive treatment by at least one step while maintaining normal home blood pressure measurements (< 135/85 mm Hg).
TAKEAWAY:
A higher proportion of patients in the adrenalectomy group were able to reduce antihypertensive treatment by at least one step while maintaining normal home blood pressure measurements than those in the conservative management group (46% vs 15%; adjusted risk difference, 0.34; P = .0038).
= .0038). Among the patients who underwent adrenalectomy, more than half (52%) were able to discontinue all antihypertensive medications while maintaining normal systolic home blood pressure measurements (< 135 mm Hg); however, none of the patients achieved this after conservative management.
Serious adverse events were reported in 35% of patients who underwent adrenalectomy and 31% of those who received conservative management, with no deaths reported in either group.
IN PRACTICE:
"For individuals with hypertension and clear biochemical evidence of MACS, especially those with larger adrenal adenomas, this study helps support the case for adrenalectomy," experts wrote in a commentary.
SOURCE:
This study was led by Antoine Tabarin, MD, Department of Endocrinology, Diabetology, Metabolism and Nutrition, CHU Bordeaux, Bordeaux, France. It was published online on May 12, 2025, in The Lancet Diabetes & Endocrinology .
LIMITATIONS:
This study was limited by a small sample size. The criteria used for diagnosing adrenal insufficiency might have led to the overdiagnosis and potential overtreatment of patients. The findings cannot be extrapolated to patients with bilateral adrenal incidentalomas and MACS.
DISCLOSURES:
This study was supported by a grant from the French Ministry of Health, and the German part of the study was additionally supported by the German Research Foundation. Some authors reported receiving honoraria, research grants, and support for attending meetings and having several other ties with various pharmaceutical companies and other sources.
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