Hypertension, i.e. high blood pressure, is very common but it is not widely known that many cases of hypertension can be corrected surgically. In particular, hypertension is divided into two categories, primary and secondary. Primary hypertension is due to age and is treated with drugs. However, surgery can solve problems of secondary hypertension.

“Secondary makes up 20% of hypertension cases and usually comes from a tumor in the adrenal glands. This tumor, or adrenal adenoma, autonomously secretes hormones that raise blood pressure, such as cortisol, aldosterone, and adrenaline. By removing the adrenal tumor 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 is increased”, points out Mr. Aristotelis Kechagias MD PHD FACS General Surgeon, Endocrine Surgeon, specializing in Advanced Laparoscopic Surgery, Director of the Ith Surgical Clinic Metropolitan General.

What are adrenal glands?

“To make it easier to understand,” he continues, “the adrenal glands are two small glands located at the very back of the abdomen, called the retroperitoneum, in the waist area. They normally secrete hormones that are vital since they regulate blood pressure, and metabolism in general.

Many adrenal tumors are found on random work-up such as a CT scan ordered for another reason (eg, appendicitis), so these tumors are called ‘random’.

Other times, a targeted test with an axial or magnetic resonance imaging is performed because the patient suffers from syndromes due to high levels of adrenal hormones. Like for example Cushing’s syndrome due to high cortisol which causes hypertension, diabetes, obesity and many other problems. In primary hyperaldosteronism we have high aldosterone with hypertension with gradual destruction of the heart and blood vessels. In pheochromocytoma, we have an oversecretion of adrenaline and noradrenaline, especially in moments of stress, with paroxysmal hypertension, headaches, tachycardia and dizziness.”

Adrenal gland removal surgery

“Surgery to remove the adrenal gland is necessary:

1. When the hormone test confirms that there is a high value of any of the adrenal hormones, and regardless of whether the adrenal gland is small or large in size. This is how the hormonal problem is corrected.
2. In the event that the adrenal tumor does not produce hormones but is large – over 4 cm – in which case 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 tumor is less than 4 cm but grows in successive axial scans or, although small, it already raises suspicion of cancer in the axial or magnetic scans.

Regarding the technical part of the operation, great strides have been made thanks to the special retroperitoneal technique, in contrast to the older laparoscopic operation. The Retroperitoneal Surgery is offered in only a few centers worldwide and is the epitome of Minimally Invasive Surgery because it is done with 3 small holes in the waist area. There is the adrenal gland which is easily removed because the surgeon does not come across any other organ unlike the common laparoscopic operation. The hospitalization is less than 24 hours, the pain is minimal to none, and with an immediate return to everyday life”, concludes Mr. Kehagias.

*The Clinic has introduced our own modification of the retroperitoneal technique to remove giant adrenal tumors (again using 3 small holes) which will be the subject of the talk at Pan-European Congress of Endoscopic Surgery in June 2024 in Maastricht