Aspects of surgically correctable hypertension as seen at the Kenyatta National Hospital

Abstract

Secondary hypertension contributes 5-101 of all forms of hypertension in general. A smaller number of those with secondary hypertension undergo surgery to correct the hypertension . In this study, a total of 34 patients were collected over a ten-year period - from January 1977 to December 1987. This is out of a total number of 1,325 recorded and diagnosed as hypertensives representing 2.6$ . Fourteen had Cushing's syndrome, 12 had coarctation of the aorta and 8 had phaechromocytoma. Cushing's syndrome presented with symptoms of polyuria and polydipsia in all patients and general body swelling in 50$. Common signs included a raised blood pressure 50$, skin hyperpigmentation 50$ and abdominal striae 50$. Elevation of serum cortisol levels and estimation of 17-ketosteroids in urine confirmed the diagnosis Anatomical localisation of the tumour was possible in 50$ of the cases using ultrasound, skull x-rays and CT scans. 50$ of the patients had surgery, 5 had adrenalectomies and 2 had hypophysectomy. The rest were awaiting surgery. Good blood pressure control was achieved in 5 patients, while one had a fair blood pressure control and the other, no control was achieved. There was no mortality. ' j 12 patients were found to have coarctation of the aorta. Three were children who presented with heart failure, cyanotic attacks, and failure to thrive. The adults presented with a rised blood pressure. 7S% of the patients had femoral pulse delay and confirmation of the diagnosis was made with aortograms and echocardiography. Nine patients were operated on and 6 had prosthetic repair; end to end anastomosis was possible in one patient, the last one had a prosthetic by-pass operation. Good pressure control was achieved in 7 patients. No change in blood pressure was noted in 2 patients. There was no operative or postoperative mortality. Phaechromocytoma was found in 8 patients. Presentation was mainly with paroxysmal attacks of palpitations, headaches and excessive sweating. Elevated blood pressure was present in all the 8 patients. Diagnosis was confirmed by elevated levels of serum catecholamines and demonstration of the metabolic product, vanillylmanderic acid (VMA) in urine. Anatomical localisation of the tumour was possible with ultrasound and I.V.U. and using the modern CT scan. 7 patients were operated on. Five patients had adrenalectomies for the removal of the tumours, one had a tumour localised in the bladder which was excised and one had a tumour localised in the organ of Zukerkandl. In one patient, the tumour was not localised even after exhaustive search at laparotomy. Good pressure control was possible in three patients. 3 had fair blood pressure control and in one there was no control (tumour not removed). Although the incidence of these diseases is low, it is important to emphasize the usefulness of a careful history, good physical examination and a thorough screening of all hypertensives. With the modern ultrasound, CT scan,£ elective angiography, the anatomical localisation of the primary lesion should be nossible. It is important to do serum hormonal estimation of cortisol and catecholamines where there is a high index of suspicion, of phaechromocytoma ot* Cushings syndrome.