Hypertensive crisis during the resection of an adrenal tumor in primary aldosteronism.

Primary aldosteronism is one of the few causes of hypertension which is subject to total surgical treatment, but a hypertensive crisis can occur during the resection of the adrenal tumor. We undertook this study to evaluate the relationship between hormonal factors and a hypertensive crisis during surgery. Sixteen patients with primary aldosteronism who were scheduled for the resection of an adrenal tumor were participated in this investigation. Hormonal factors and hemodynamic variables were evaluated before induction of anesthesia, after induction of anesthesia, 30 minutes after the incision, during tumor manipulation, during resection, and immediately after surgery. During tumor manipulation, a hypertensive crisis occurred in six patients (hypertensive group; HG) but not in any others (non-hypertensive group; NHG). There were no differences in hormonal levels, except epinephrine, during tumor manipulation between HG and NHG. Hemodynamic evaluations revealed an increase of systemic vascular resistance during the hypertensive crisis. We conclude that the hypertensive crisis during the manipulation of an adrenal tumor is caused by the rapid release of epinephrine from the manipulated adrenal gland.