THE CLINICAL COURSE, FOLLOWING ADRENAL RESECTION AND SYMPATHECTOMY, OF 82 PATIENTS WITH SEVERE HYPERTENSION

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Abstract
A clinical report is presented of 82 severely hypertensive patients following various degrees of adrenal resection with and without various types of sympathectomy. The indications for operation include three features: (1) average diastolic blood pressure of 120 mm. Hg. or more;(2) failure to respond to intensive medical therapy; (3) evidences of progressive vascular damage. Our tentative contraindications include any one of the following: (1) poor renal function, with excretion of less than 20% of phenolsulfonphthalein 15 min. after intraven. injn., and/or a blood urea N of over 20 mg. %; (2) convalescence from a stroke or coronary occlusion for less than 6 months; (3) age of 55 years or more; (4) inability forany reason to cooperate in taking adrenal cortical replacement therapy. The majority (54) of patients have been subjected to an Adson type of sympathectomy, plus either subtotal or total adrenalectomy. In the case of subtotal adrenalectomy, all adrenal tissue is removed save a remnant about 6 mm. in diam. adjacent to the adrenal vein on the left side. These operations are performed through a subdiaphragmatic, retroperitoneal approach in 2 stages about 10 days apart. Further observation will be required to determine whether the Adson type of sympathectomy, combined with total or subtotal adrenalectomy, is more or less effective than thoracolumbar sympathectomy, or total adrenalectomy without sympathectomy.