Conduite à tenir face à un incidentalome surrénalien associé à une hypertension artérielle

Hypertension (HTA) is a very common disease but its origin is well knowed only in 1 to 5% of the cases. HTA is present in half of the patients who have an adrenal incidentaloma. Clinical data, hormonal sampling, computed tomography and adrenal scintigraphies are necessary to identify hyperfunctioning adrenal tumors. Adrenalectomy is indicated in case of potential malignant tumors and hyperfunctioning tumors. If HTA seems to be not in relation with the adrenal mass, it is recommanded to recognize a congenital enzymatic block in order to ovoid an unnecessary adrenalectomy and to search for a pre clinical Cushing's syndrome. The last one is associated with HTA in 91% of the cases, and with a morbid obesity, mellitus diabetes or dyslipidemia in 50% of the cases. The removal of the adrenal mass improves the HTA for half of the patients. If the adrenocortical tumor is nonfunctioning, patients have to be followed during a long time. HTA will be considered as “essential” after a new comprehensive analysis performed 3 years later.