OBSERVATIONS ON THE RESULTS OF SUBTOTAL ADRENALECTOMY IN THE TREATMENT OF SEVERE, OTHERWISE INTRACTABLE HYPERTENSION AND THEIR BEARING ON THE MECHANISM BY WHICH HYPERTENSION IS MAINTAINED

Abstract

Radical excision of adrenal tissue ranging from approx. 90% to complete adrenalectomy was performed in 23 patients with arterial hypertension. This procedure was used only in cases of advanced disease regarded as unpromising candidates for thoraco-lumbar sympathectomy. In 6 cases abdominal sympathectomy (Adson type) was combined with subtotal adrenalectomy. Four deaths have occurred, 2 about one week after operation and 2 later from recurrent cerebral vascular episodes. The arterial blood pressure has been reduced by subtotal adrenalectomy alone in some but not in all cases, from extremely high levels to a normal range with marked symptomatic improvement, relief from heart failure, improvement in renal plasma flow and reduction in cerebral vascular resistance. The combination of subtotal adrenalectomy and limited sympathectomy has yielded more consistently good results than adrenalectomy alone, although many more cases and longer periods of opservation will be required to warrant a conclusion. In one patient in whom thoraco-lumbar sympathectomy and unilateral adrenalectomy had failed to control severe hypertension, the blood pressure has been maintained in a low normal range for over a year and without need for adrenal cortical replacement therapy during the past 9 months, following the removal of approx. 90% of the remaining adrenal gland.