Primary Aldosteronism

doi:10.1059/0003-4819-90-3-386

Primary Aldosteronism

Diagnosis, Localization, and Treatment

Indianapolis, Indiana; Nashville, Tennessee; and Oklahoma City, Oklahoma

Abstract

New diagnostic techniques have enhanced the detection of primary aldosteronism. However, the response of blood pressure after operation in unilateral and bilateral adrenal disease is different. We have compared four localizing techniques—adrenal venography, adrenal isotopic scanning, a modified adrenal venous sampling for steroid measurements, and the anomalous postural decrease in plasma aldosterone concentration—in 51 patients with primary aldosteronism, all of whom had undergone operative confirmation. Adrenalectomy resulted in normal blood pressure in 59%, improvement in 25%, and no change in 16%. Correct localization of the lesion was obtained in 47% by the adrenal isotopic scan, in 66% by adrenal venography, and in 91% by the modified adrenal venous hormone technique despite four false-positives. Of the 26 patients with an anomalous postural decrease in plasma aldosterone, 88% had a unilateral lesion.

Article and Author Information

▸From the Departments of Internal Medicine, Radiology, Nuclear Medicine, and Urology, Indiana University School of Medicine, Indianapolis, Indiana; Vanderbilt University School of Medicine, Nashville, Tennessee; and the Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma.
Grant support: in part by U.S. Public Health Service grants HL-14159(IN) and HL-14192(TN), Specialized Center of Research (SCOR) in Hypertension, HL-19279(OK) and RR-00095(TN) and RR-00750(IN), RR-00062(OK) (General Clinical Research Centers).
A preliminary report of these studies was presented at the Annual Session of the American College of Physicians, San Francisco, California, April 1975, and the Western Society for Clinical Research, Carmel, California, 1978.
▸Requests for reprints should be addressed to Myron H. Weinberger, M.D.; Specialized Center of Research in Hypertension, Indiana University School of Medicine, 1100 West Michigan Street; Indianapolis, IN 46202.
- Received June 16, 1978.
- Accepted December 20, 1978.