Table 4. Effect of surgical therapy for hypercortisolism on hypertension.
| Study, year | Patients, n | Etiology of hypercortisolism, n | Hypertension at baseline, n (%) | Therapy, % | Duration of follow up after surgery, mean, month | Hypertension at follow up |
|---|---|---|---|---|---|---|
| Gómez et al., 2007 (71) | 71 | CD: 50 | 71/71 (100%) | Transsphenoidal surgery: 100% | 24 | Resolution: 75% |
| Adrenal CS: 21 | Adrenalectomy: 100% | |||||
| Chow et al., 2008 (48) | 68 | CD: 42 | 25/42 (60%) | Bilateral adrenalectomy: 100% | Not reported | Resolution: 64% |
| Ectopic CS: 26 | 19/26 (73%) | |||||
| Sippel et al., 2008 (72) | 60 | CD: 17 | 46/59 (78%) (missing data in 1 subject) | Unilateral adrenalectomy: 53%, Bilateral adrenalectomy: 47% | 24 | Improvement: 67%, mean number of antihypertensive medications decreased from 1.6 pre-operatively to 0.4 post-operatively |
| Adrenal CS: 33 | ||||||
| Ectopic CS: 10 | ||||||
| Alesina et al., 2010 (73) | 170 | Adrenal CS: 97 | 68/97 (70%) | Adrenalectomy: 100% | 70.9 | Resolution: 32%; Improvement: 24% |
| Adrenal MACS: 63 | 50/63 (79%) | Resolution: 16%; Improvement: 20% | ||||
| Hassan-Smith et al., 2012 (47) | 72 | CD: 72 | 56/72 (78%) | Transsphenoidal surgery: 100% | 55.2 | Resolution: 32%; Improvement: 30% |
| Ntali et al., 2013 (74) | 311 | CD: 311 | 151/311 (49%) | Transsphenoidal surgery: 99% | 108 | Improvement: 11% |
| Medical therapy: 1% | ||||||
| Terzolo et al., 2014 (28) | 51 | CD: 33 | 32/51 (63%) | Transsphenoidal surgery: 100% (2 received radiotherapy, ketoconazole/cabergoline before surgery) | 56.5 | Resolution: 66% |
| Adrenal CS: 15 | ||||||
| Ectopic CS: 3 | ||||||
| Bancos et al., 2016 (57) | 584 | Adrenal MACS: 584 | Pooled proportion: 61% | Adrenalectomy: 120 | At least 6 months | Improvement: pooled 61%, mean SBP and DBP decreased by 12.7 and 9.3 mmHg |
Selection criteria: publication year: 2005 or after; sample size: above 50 subjects; design: retrospective, prospective studies or systematic reviews; intervention: surgical treatment; outcome: hypertension prevalence data available at baseline and after treatment. CS, Cushing syndrome; CD, Cushing disease; MACS, mild autonomous cortisol secretion; SBP, systolic blood pressure; DBP, diastolic blood pressure.