RSS Feeds
Medical Management of Aldosterone-Producing Adenomas
- Ranjan P. Ghose, MD;
- Phillip M. Hall, MD; and
- Emmanuel L. Bravo, MD
- Cleveland Clinic Foundation; Cleveland, OH 44195 (Ghose) Cleveland Clinic Foundation; Cleveland, OH 44195 (Hall) Cleveland Clinic Foundation; Cleveland, OH 44195 (Bravo)
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We agree that the results from our study were similar to those found by Ferris (1) and Brown (2) and colleagues. We were aware of these studies, but in the editing process, the word “recent” was erroneously omitted in the first sentence of the abstract. This sentence should have read: “No recent data are available … .” Our intention was not to disregard these researchers' important contribution to this field.
The correspondents were also concerned about the methods for diagnosing aldosterone-producing adenoma in our patients and the accuracy with which computed tomography can diagnose these adenomas in patients with biochemical evidence of primary aldosteronism. We agree that the possibility of incidentaloma cannot be ruled out in these cases, but we believe that confirming the diagnosis with a study as invasive, expensive, and technically difficult as adrenal-vein sampling is often unnecessary. In Doppman and colleagues' study (3), computed tomography had a positive predictive value of 0.89 for the detection of adenoma. Some investigators suggest that if the triad of hypokalemia, hypertension, and a unilateral adrenal mass is present, then surgery is indicated without confirmation by adrenal-vein sampling (4). In our study, all patients were treated medically for various reasons. Eight of the 24 patients in our study eventually had surgical excision of the tumor with subsequent development of normokalemia, confirming the presence of a functioning tumor. If some patients had had biochemical evidence for hyperaldosteronism with bilateral hyperplasia and an incidentaloma, medical management would have been appropriate, making it an inconsequential error in our patients.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
