Which form of hypertension is effectively treated with surgery? A Greek expert answers

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Dr. Aristotelis Kehagias explains to Ygeia Mou when surgery is required to treat secondary hypertension.

Hypertension, i.e., high blood pressure, is very common, but it is not widely known that many cases can be corrected surgically. Hypertension is divided into two categories.

Primary hypertension is due to age and is treated with drugs.

Surgical treatment can solve secondary hypertension problems. Secondary hypertension makes up 20% of hypertension cases and usually originates from a tumour in the adrenal glands. This tumour, or adrenal adenoma, autonomously secretes hormones that raise blood pressure, such as cortisol, aldosterone, and adrenaline.

By removing the adrenal tumour with the new retroperitoneal operation, the problem of secondary hypertension is corrected, the risk of cardiovascular diseases is significantly reduced, and the duration and quality of life are increased.

What are adrenal glands?

To make it easier to understand, the adrenal glands are two small glands located at the very back of the abdomen, called the retroperitoneum, in the waist area. Normally, they secrete vital hormones as they regulate blood pressure and, in general, metabolism.

Many adrenal tumours are found at random, such as through a CT scan ordered for another reason (e.g., appendicitis). Other times, a targeted test is performed with an axial or magnetic resonance imaging because the patient suffers from syndromes due to the high levels of adrenal hormones.

For example, Cushing's syndrome is due to high cortisol, which causes hypertension, diabetes, obesity and many other problems.

In primary hyperaldosteronism, there is high aldosterone with hypertension, with gradual destruction of the heart and blood vessels. In pheochromocytoma, there is an overexcretion of adrenaline and noradrenaline, especially in moments of stress, with paroxysmal hypertension, headaches, tachycardia and dizziness.

The operation to remove the adrenal gland is necessary:

1. When the hormone test confirms that there is a high amount of any of the adrenal hormones regardless of whether the adrenal gland is small or large in size. Thus, the hormonal problem is corrected.

2. If the adrenal gland tumour does not produce hormones but is large—over 4 cm—it is removed to prevent or treat a malignancy. The possibility of malignancy increases the larger the adrenal adenoma. Adenomas larger than 6 cm have a greater than 25% chance of malignancy.

3. When the tumour is less than 4 cm but grows in successive axial scans or, although small, it already raises the suspicion of cancer in the axial or magnetic scans.

As far as the technical part of the operation is concerned, great strides have been made, thanks to the special retroperitoneal technique, in contrast to the older laparoscopic operation.

The retroperitoneal operation is performed in very few centres worldwide and is the epitome of Minimally Invasive Surgery because it is done with three small holes in the waist area. There is the adrenal gland, which is easily removed because the surgeon does not encounter any other organ, unlike the common laparoscopic operation.

Hospitalisation is less than 24 hours, the pain is minimal to none, and there is an immediate return to everyday life.

Our Clinic has introduced our own modification of the retroperitoneal technique to remove giant adrenal tumours (again using three small holes).

Meet the Specialist

* Mr. Aristotelis Kehagias, MD PHD FACS, is a General Surgeon and endocrine Surgeon specialising in Advanced Laparoscopic Surgery and Director of the Surgical Clinic of Metropolitan General.

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This piece was written for Greek City Times by a Guest Contributor

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