*Corresponding author email: ali.lounici@univ-tlemcen.dz Symbiosis Group Symbiosis www.symbiosisonline.org www.symbiosisonlinepublishing.com ISSN Online: 2374-6890 Adrenal Adenoma Causing Secondary Hypertension. A Review of the Literature Ali Lounici*, Esma Tabti, Abdelghani Benmekki & Mohammed Hadi Bestaoui Department of Internal Medicine, University Aboubekr Belkaid, Tlemcen, Algeria Journal of Endocrinology and Diabetes Open Access Review Article Abstract Arterial hypertension (HTN) of endocrine origin accounts for 5 to 10% of cases of secondary hypertension. Although this form of hypertension is rare, the identification and treatment of the underlying cause could lead to healing or significant improvement in hypertension, thereby decreasing the cardiovascular risk and morbidity associated with hypertension. Endocrine causes of secondary hypertension are primary hyperaldosteronism, pheochromocytoma, Cushing’s syndrome (CS), acromegaly, hyperparathyroidism, congenital adrenal hyperplasia, hypothyroidism, hyperthyroidism and secretory tumors of renin. The adrenal hypertension is the most frequent and the most frequently curable. Epidemiological data on hypertension associated with CS are largely retrospective. However, the available data suggested that 70– 85% of adult patients with endogenous CS suffer from hypertension, compared to approximately 20% of patients long-term treated with exogenous corticosteroids. The mechanisms involved in the development of hypertension during CS are complex and only partially understood. The main data concerning the renin-angiotensin system, the mineral corticoid activity, the sympathetic nervous system and the vasoregulatory system, together with the indirect mechanisms, which contribute to the development of CS-related hypertension. The definitive therapy of CS-related hypertension is the surgical removal of the tumor responsible for the disease. Interestingly, mortality data show that adequate control of hypercortisolemia does not always lead to BP normalization. Some studies show a normalization of increased cardiovascular risk after immediate surgical cure of Cushing’s disease, while others did not. Key words: Adrenal Adenoma; Secondary Hypertension; Cushing’s Syndrome Received: December 03,2018; Accepted: December 13,2018; Published: : December 17,2018 *Corresponding author : Ali Lounici, Department of Internal Medicine, University Aboubekr Belkaid, Tlemcen, Algeria. E-mail: ali.lounici@univ-tlemcen.dz Introduction In our observation, we describe the case of 23-year-old man with hypertension associated with paraparesis of the lower limbs revealing a Cushing syndrome due to a left adrenal adenoma. After chirurgical excision of the adrenal mass, our patient normalized his blood pressure with 3 years of follow up. This case illustrates a form of endocrine hypertension of adrenal origin and the need for a careful clinical examination during the discovery of hypertension in the young subject in order to carry out adequate balance sheets to search for a curable cause of secondary hypertension [1]. Epidemiology of endocrine hypertension Arterial hypertension (HTN) of endocrine origin accounts for 5 to 10% of cases of secondary hypertension [2]. Although this form of hypertension is rare, the identification and treatment of the underlying cause could lead to healing or significant improvement in hypertension, thereby decreasing the cardiovascular risk and morbidity associated with hypertension. Endocrine causes of secondary hypertension are primary hyperaldosteronism, pheochromocytoma, Cushing’s syndrome (CS), acromegaly, hyperparathyroidism, congenital adrenal hyperplasia, hypothyroidism, hyperthyroidism and secretory tumors of renin. The adrenal hypertension is the most frequent and the most frequently curable [3]. Definition and Classification of Cushing Syndrome Cushing’s syndrome, or chronic hypercortisolism, is a severe endocrine disease due to the prolonged exposure to glucocorticoid excess. The endogenous Cushing’s syndrome, caused by the endogenous over production of cortisol by the adrenal glands, is secondary to an adrenocorticotrophin (ACTH)-secreting pituitary tumor [pituitary-dependent Cushing’s syndrome (CS) or Cushing’s disease (CD)] in around 70%, a cortisol-secreting adrenal lesion (adrenal-dependent Cushing’s syndrome) in 15–20%, and an ACTH-secreting extra-pituitary tumor [ectopic Cushing’s syndrome (ECS)] in 10–15% of the cases. The chronic administration of exogenous corticosteroids for different clinical conditions may induce the development of an exogenous CS [4–6]. The diagnosis may be late and secondary to a metabolic complication. The circumstances of discovery are essentially facio-truncal obesity; signs of skin fragility, stretch marks, muscular weakness by amyotrophy, hypertension, diabetes and osteoporosis [7]. Epidemiology of Hypertension Associated with CS Epidemiological data on hypertension associated with CS are largely retrospective. However, the available data suggested that 70–85% of adult patients [8, 9] with endogenous CS suffer from