Diagnosis and Surgical Treatment of Adrenal Origin Arterial Hypertension

The dissertation is devoted to a comprehensive study of the diagnosis and surgical treatment of adrenal origin arterial hypertension — a secondary form of arterial hypertension caused by pathological processes in the adrenal glands. The work examines four main clinical-morphological forms of the disease: primary hyperaldosteronism, Cushing's syndrome, pheochromocytoma, and adrenal incidentaloma. The research encompasses a wide range of diagnostic methods, including laboratory, pharmacological, functional, instrumental, and morphological approaches. Special attention is given to the comparative evaluation of various surgical approaches in adrenalectomy, including thoracophrenotomy in the 10th intercostal space, as well as the analysis of intraoperative and postoperative complications. The practical significance of the work is determined by the implementation of the obtained results in the clinical practice of departments of surgical gastroenterology, endocrinology, and general surgery in Bishkek.

Relevance of the Problem.

At present, the diagnosis and treatment of adrenal origin arterial hypertension continues to remain an urgent problem for both therapists and surgeon-endocrinologists. In this category of patients, in addition to hormonal disorders, arterial hypertension is present that does not respond to medical correction, often with a severe clinical course and development of complications. Secondary arterial hypertensions account for up to 20% of all causes of elevated blood pressure, of which 15-25% are arterial hypertensions of adrenal origin [16, 51, 142, 198, 238].

To identify most forms of adrenal origin arterial hypertension, a wide range of laboratory and instrumental investigations is required. Improving the diagnostic results of this pathology is associated with the introduction into clinical practice of modern imaging methods - ultrasound, CT, and MRI [5, 69, 112, 121', 188].

Researchers agree that surgical intervention is the primary method of treatment for adrenal diseases accompanied by arterial hypertension, allowing clinical recovery in most cases both in the early and late postoperative period [51, 142, 152, 190, 239].

Adrenalectomy is classified as an operation of sufficiently high complexity, which may be accompanied by a significant number of postoperative complications. The choice of surgical access largely determines the probability of developing intraoperative complications [18, 69, 92, 152].

To date, certain questions remain unresolved or debatable - the diagnosis of various clinical-morphological forms of adrenal origin arterial hypertension, the capabilities of instrumental diagnostic methods, and the evaluation of the effectiveness of surgical treatment in the early and late postoperative period.

Goal of the Research.

Study of the Results of Diagnosis and Surgical Treatment of Adrenal Origin Arterial Hypertension.

Research Tasks:

1. To study the features of the clinical course and laboratory diagnosis in patients with adrenal origin arterial hypertension.

2. To determine the diagnostic value of ultrasonography and computed tomography methods in the diagnosis of organic lesions of the adrenal glands in adrenal origin arterial hypertension.

3. To conduct a comparative evaluation of various surgical approaches in adrenalectomy in patients with adrenal origin arterial hypertension.

4. To evaluate the effectiveness of surgical treatment of patients with adrenal origin arterial hypertension based on the study of adrenalectomy results in the early and late postoperative period.

Scientific Novelty.

The features of the clinical course and laboratory diagnosis in patients with adrenal origin arterial hypertension have been studied.

The diagnostic value of ultrasonography and computed tomography methods in the diagnosis of organic lesions of the adrenal glands in adrenal origin arterial hypertension has been determined.

Based on the evaluation of early and late results, the effectiveness of surgical treatment of patients with adrenal origin arterial hypertension has been demonstrated.

Practical Significance.

The results of clinical, laboratory, and instrumental examination of patients with adrenal origin arterial hypertension in primary hyperaldosteronism, Cushing's syndrome, pheochromocytoma, and incidentaloma have been studied.

Based on the analysis of intraoperative complications, the preference for using the thoracophrenotomy surgical approach in the 10th intercostal space in adrenalectomy in patients with adrenal origin arterial hypertension has been demonstrated.

Main Propositions to be Defended.

Comprehensive clinical, laboratory, and instrumental examination of patients with adrenal origin arterial hypertension allows diagnosing the presence and location of organic lesions of the adrenal glands, as well as differentiating the nosological form of adrenal gland damage.

Adrenalectomy is an effective method of treatment for adrenal origin arterial hypertension. The surgical approach - thoracophrenotomy in the 10th intercostal space - allows reducing the risk of developing intraoperative complications during surgical interventions on the adrenal glands.

Implementation of the Obtained Results.

The results of the research have been implemented in the clinical practice of the Department of Surgical Gastroenterology and Endocrinology of the General Surgery Clinic named after I.K. Akhunbaev of the National Hospital under the Ministry of Health of the Kyrgyz Republic and the Department of Surgery of the City Clinical Hospital of Emergency Medical Aid No. 4 in Bishkek.

Validation of the Work.

The main provisions of the dissertation were reported at the scientific-practical conference "Unified Educational Space of the 21st Century" dedicated to the 10th anniversary of the establishment of the KRSU (Bishkek, 2003); at the 11th Russian Symposium on Surgical Endocrinology (Saint Petersburg, 2003); at the 12th Russian Symposium on Surgical Endocrinology (Yaroslavl, 2004); at the scientific-practical conference of the Medical Faculty of the Kyrgyz-Russian Slavic University (Bishkek, 2004); at the X International Conference of Young Scientists and Specialists (Bishkek, 2004); at the joint meeting of the staff of the Department of Hospital Surgery and the Department of General and Faculty Surgery of the Kyrgyz-Russian Slavic University, the Department of Surgical Diseases No. 1 of the Kyrgyz State Medical Academy, and the staff of the General Surgery Clinic named after I.K. Akhunbaev of the National Hospital under the Ministry of Health of the Kyrgyz Republic (Bishkek, 2005).

Publications.

9 scientific works have been published on the topic of the dissertation.

Volume and Structure of the Dissertation.

The dissertation is presented on 147 pages of computer typesetting in Russian. The dissertation consists of an introduction, 4 chapters, conclusion, conclusions,