Adrenal-dependent hypertension

Accurate diagnosis and appropriate surgical management can result in the cure of adrenal-dependent hypertension. Two surprises in mineralocorticoid excess are: (1) primary aldosteronism is more prevalent than previously believed, and (2) CT imaging of the adrenals is of limited use in distinguishing unilateral from bilateral adrenal disease. Therefore, if surgery is considered for primary aldosteronism in patients over 40 years, AVS is an essential diagnostic step. The diagnosis and the treatment of adrenal-dependent Cushing syndrome are usually straightforward. However, because of treatment failures or inability to localize the source of ACTH secretion, bilateral laparoscopic adrenalectomy is becoming a more frequently used treatment option. Although the prevalence of pheochromocytoma has not changed over the years, more patients are being diagnosed in the presymptomatic state because of the wide-spread use of computed imaging. The surgeon should be aware of the advantages and disadvantages of some of the new diagnostic tools, such as fractionated plasma-free metanephrines.