Polymorphic variation of CYP11B2 predicts postoperative resolution of hypertension in patients undergoing adrenalectomy for aldosterone-producing adenomas.
OBJECTIVE
The surgical cure rate of patients with aldosterone-producing adenoma varies widely, and causes of persistent hypertension are not completely established. The objective of this study was to assess the blood pressure outcome in patients after retroperitoneoscopic adrenalectomy, and to analyze the CYP11B2 344 C/T polymorphism and any factors associated with the outcome.


METHODS
Between 2002 and 2009, 82 patients with unilateral aldosterone-producing adenoma underwent retroperitoneoscopic adrenalectomy. Clinical and biochemical data were reviewed retrospectively. Patients were investigated to assess the association of the CYP11B2 344 C/T polymorphism with resistant hypertension after surgery.


RESULTS
Adrenalectomy cured hypertension in 44 patients (53.7%), and 27 patients (32.9%) had persistent hypertension that was much easier to control after surgery, whereas 11 patients (13.4%) had continued hypertension and poor blood pressure control. Multivariate regression analysis showed that the main determinants of postoperative cure were duration of hypertension less than 5 years (OR 4.515, 95% CI 1.978-10.293), number of antihypertensive medications ≤2 (OR 2.639, 95% CI 1.154-6.035), preoperative response to spironolactone (OR 3.105, 95% CI 1.381-6.985) and the TT genotype of the CYP11B2 gene (344 C/T; OR 2.765, 95% CI 1.261-6.064).


CONCLUSIONS
The 344 C/T polymorphism of the CYP11B2 gene predicts resolution of hypertension in patients undergoing adrnelactomy for aldosterone-producing adenoma. Duration of hypertension, number of antihypertensive medications, and preoperative response to spironolactone also represents predictive factors that need to be considered for the identification of patients with continued postoperative hypertension requiring long-term monitoring and treatment.
Department of Urology, Guangzhou General Hospital of Guangzhou Military Command (Guangzhou Liuhuaqiao Hospital), Guangzhou, Guangdong, China. huwl-mr@vip.sina.com
Wei
W
Wang
Wei Lie
WL
Hu
Li Chao
LC
Zhang
Yuan Song
YS
Xiao
Jun
J
Liu
Chen
C
Bin
D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000235:genetics / Q000378:metabolism / Q000601:surgery*; D000315:Adrenalectomy; D018246:Adrenocortical Adenoma / Q000150:complications / Q000235:genetics / Q000378:metabolism / Q000601:surgery*; D000450:Aldosterone / Q000378:metabolism; D019405:Cytochrome P-450 CYP11B2 / Q000235:genetics*; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000235:genetics / Q000378:metabolism / Q000601:surgery*; D006973:Hypertension / Q000209:etiology / Q000235:genetics / Q000601:surgery*; D010535:Laparoscopy; D011110:Polymorphism, Genetic; D012074:Remission Induction; D012187:Retroperitoneal Space; D012307:Risk Factors
D000450:Aldosterone; D019405:Cytochrome P-450 CYP11B2