Abstract
Since 1974 primary aldosteronism has been diagnosed in 71 patients in our outpatient clinic. Thirty-four patients had a unilateral aldosterone-producing adenoma, whereas bilateral adrenal hyperplasia was diagnosed in 37 patients. Although at the time of diagnosis the mean potassium values were lower and mean aldosterone levels were higher in patients with an adenoma, as compared to those with bilateral hyperplasia, these laboratory data did not allow us to differentiate between the two leading causes of primary aldosteronism in the individual patient due to pronounced overlap of laboratory values between the two groups. During the first few years, a successful differential diagnosis was made by adrenal phlebography and separate sampling of plasma aldosterone in both adrenal veins; later non-invasive imaging techniques such as computed tomography and radionuclide scanning were used. The best results were obtained in patients with adenoma who underwent adrenalectomy. Fifty-six percent of these patients were clinically and biochemically cured; 28% were improved and had normal blood pressure values during drug treatment. In contrast, patients with bilateral hyperplasia were treated pharmacologically, but only in half of the patients could normal blood pressure values be achieved. Two thirds of the male patients developed gynecomastia during spironolactone treatment. As expected, unilateral adrenalectomy was unsuccessful in the 7 patients with bilateral hyperplasia who underwent surgery. Our results confirm that surgical treatment of adrenal adenomas and drug treatment of bilateral hyperplasias are the appropriate therapy in primary aldosteronism. A differential diagnosis cannot be made on the basis of clinical and non-invasive laboratory data alone; imaging techniques have to be included in the diagnostic process. The long-term clinical outcome was more favorable in patients with an adrenal adenoma that can be removed surgically than in patients with idiopathic hyperplasia of both adrenal glands.
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Abbreviations
- APA:
-
Aldosterone producing adenoma
- IHA:
-
Idiopathic hyperaldosteronism
References
Auda SP, Brenan MF, Gill JR (1980) Evolution of the surgery management of primary aldosteronism. Ann Surg 191:1–7
Biglieri EG, Kater CE, Arteaga EE (1984) Primary aldosteronism is comprised of primary adrenal hyperplasia and adenoma. J Hypertens 2[Suppl 3]: 259–261
Bravo EL, Tarazi RC, Dustan HP, Fouad FM, Textor SC, Gifford RW, Vidt DG (1983) The changing clinical spectrum of aldosteronism. Am J Med 74:641–651
Bravo EL, Fouad FM, Tarazi RC, Pohl M, Gifford RW, Vidt DG (1988) Clinical implications of primary aldosteronism with resistant hypertension. Hypertension 11 [Suppl I]: 207–211
Brown JJ, Davies DL, Ferris JB, Fraser R, Haywood, Lever AF, Robertson JIS (1972) Comparison of surgery and prolonged spironolactone therapy in patients with hypertension, aldosterone excess, and low plasma renin. BMJ II: 729–734
Clark E (1965) Spironolactone therapy and gynaecomastia. JAMA 193:157–158
Clarke D, Wilkinson R, Johnston IDA, Hacking PM, Haggith JW (1979) Severe hypertension in primary aldosteronism and good response to surgery. Lancet I: 482–485
Conn JW, Knopf RF, Nesbit RM (1964) Clinical characteristics of primary aldosteronism from analysis of 145 cases. Am J Surg 107:159–172
Ferris JB, Brown JJ, Fraser R, Haywood E, Davies DL, Kay AW, Lever AF, Robertson JIS, Owen K, Peart WS (1975) Results of adrenal surgery in patients with hypertension, aldosterone excess, and low renin concentration. BMJ I: 135–138
Ferris JB, Brown JJ, Fraser R, Lever AF, Robertson JIS (1981) Primary hyperaldosteronism. Clin Endocrinol Metab 10:419–452
Ferris JB, Beevers DG, Boody JJ, Davies DL, Fraser R, Kremer D, Lever AF, Robertson JIS (1987) The treatment of low-renin (‘primary’) hyperaldosteronism. Am Heart J 96:729–734
Ganguly A (1982) New insights and questions about glucocorticoid suppressible hyperaldosteronism. Am J Med 67:851–854
Ganguly A, Grim CE, Weinberger MH (1982) Primary aldosteronism. Arch Intern Med 142:813–815
George JM, Wright L, Bell NH, Bartter FC, Brown R (1970) The syndrome of primary aldosteronism. Am J Med 48:343–356
Gordon RD (1989) Update on primary aldosteronism: diagnosis and management. ACE Rep 61:1–8
Grant CL, Carpenter P, Heerden JA van, Hamberger B (1984) Primary aldosteronism. Arch Surg 119:585–590
Greenblatt DJ, Koch J (1973) Adverse reactions to spironolactone. JAMA 225:40–43
Groth H, Vetter W, Stimpel M, Greminger P, Tenschert W, Klaiber E, Vetter H (1985) Adrenalectomy in primary aldosteronism: a long-term follow up study. Cardiology 72 [Suppl 1]: 107–116
Guerin MD, Wahner HW, Gorman CA, Carpenter PC, Sheedy PF (1983) Computed tomographic scanning versus radioisotopic imaging in adrenocortical diagnosis. Am J Med 75:653–657
Haber E, Koerner T, Page LB, Kliman B, Purnode A (1969) Application of a radioimmunoassay for angiotensin I to the physiologic measurement of plasma renin activity in normal human subjects. J. Clin Endocr Metab 29:1349–1355
Herwig KR (1979) Primary aldosteronism: experience with thirty eight patients. Surgery 86:470–473
Jeunemaitre X, Chatellier G, Kreft C, Charru A, Devries C, Plouin PF, Corvol P, Menard J (1987) Efficacy and tolerance of spironolactone in essential hypertension. Am J Cardiol 60:820–825
Lüscher T, Tenschert W, Salvetti A, Pedrinelli R, Turini F, Maltini G, Vetter H, Vetter W (1984) Primary aldosteronism due to adrenal carcinoma. Klin Wochenschr 62:470–476
Ma JTC, Wang C, Lam KSL, Yeoung RTT, Chan FL, Boey J, Cheung PSY, Coghlan JP, Scoggins BA, Stockigt JR (1986) Fifty cases of primary hyperaldosteronism in Hong Kong Chinese with high frequency of periodic paralysis. Evaluation of techniques for tumor localisation. Q J Med 235:1021–1037
Milsom SR, Espiner EA, Gwynne NJ, Perry EG (1986) The blood pressure response to unilateral adrenalectomy in primary aldosteronism. Q J Med 236:1141–1151
Niewoehner CB, Nutfall FQ (1984) Gynaecomastia in a hospitalised male population. Am J Med 77:633–638
Noth RH, Biglieri EG (1988) Primary aldosteronism. Med Clin North Am 72:1117–1131
Russel RP, Masi AT, Richter ED (1972) Adrenal cortical adenomas and hypertension. Medicine 51:211–225
Saruta T, Suzuki H, Takita T, Saito I, Murai M, Tazaki H (1987) Pre-operative evaluation of the prognosis of hypertension in primary aldosteronism. Acta Endocr (Copenh) 116:229–234
Schambelan M, Brust NL, Chang BC, Slater KL, Biglieri EG(1976) Circadian rhythm and effect of posture on plasma aldosterone concentration in primary aldosteronism. J Clin Endocrinol Metab 43:115–131
Sinclair AM, Isles CG, Brown I, Cameron H, Murray GD, Robertson JWK (1987) Secondary hypertension in a blood pressure clinic. Arch Intern Med 147:1289–1293
Vetter H, Siebenschein R, Studer A, Witassek F, Furrer J, Glänzer K, Siegenthaler W, Vetter W (1978) Primary aldosteronism: inability to differentiate unilateral from bilateral adrenal lesions by various routine and laboratory data and by peripheral aldosterone. Acta Endocr (Copenh) 89:710–725
Vetter H, Fischer M, Galanski M, Stieber U, Tenscher W, Baumgart P, Winterberg B, Vetter W (1985) Primary aldosteronism: Diagnosis and non-invasive lateralization procedures. Cardiology 72 [Suppl I]: 57–63
Vetter W, Vetter H, Siegenthaler W (1973) Radioimmunoassay of aldosterone without chromatography. II. Determination of aldosterone. Acta Endocr (Copenh) 74:558–567
Weinberger MH, Grim CE, Hollifield JW, Kem DC, Ganguly A, Kramer NJ, Yune HY, Wellman H, Donohue JP (1979) Primary aldosteronism. Ann Intern Med 90:386–391
Young FY, Hagan MJ, Klee GG, Grant CS, Von Heerden J (1990) Primary aldosteronism: diagnosis and treatment. Mayo Clin Proc 65:96–100
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Jeck, T., Weisser, B., Mengden, T. et al. Primary aldosteronism: difference in clinical presentation and long-term follow-up between adenoma and bilateral hyperplasia of the adrenal glands. Clin Investig 72, 979–984 (1994). https://doi.org/10.1007/BF00577740
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DOI: https://doi.org/10.1007/BF00577740