Trilostane, an inhibitor of the 3β-hydroxysteroid dehydrogenase enzyme sytem of steroid biosynthesis, was applied to 18 patients with primary aldosteronism (9 patients with adrenal adenoma, 9 patients with bilateral adrenal hyperplasia) for 12 weeks. A marked decrease in plasma aldosterone was observed during therapy combined with a reduction in blood pressure and a rise in serum potassium levels. Except for slight diarrhea in 4 patients, which did not require cessation of trilostane medication, no further side effects were observed. Trilostane proved to be an effective inhibitor of aldosterone biosynthesis and was found useful in the treatment of primary aldosteronism both in patients with adrenal adenoma and in those with bilateral adrenal hyperplasia.

In 72 patients with primary aldosteronism who were classified on the basis of adrenal pathology after adrenalectomy, analysis of routine clinical and laboratory data, of supine and upright plasma aldosterone, and of plasma renin activity were of limited value in differentiating patients with aldosterone-producing adenoma(s) (APA, n = 59) from those with idiopathic adrenal hyperplasia (IAH, n = 13). Normokalemic aldosteronism occurred in 6 patients (3 APA, 3 IAH). A correct classification of the adrenal lesion(s) was obtained in 80% of the patients by computed tomography and only in 69% by adrenal scintiscan. In addition, adrenal scintiscan was hampered by a relatively high rate of incorrect results independent of whether dexamethasone was used or not. Small adenomas ( < 1 cm) and more often adrenal hyperplasia may escape visualization by computed tomography.

The frequency of myoglobinuric renal failure is estimated between 8 and 20%. Despite early onset of therapy often the use of renal substitution by hemodialysis or hemofiltration is required. This study of the clinical course of nine patients with myoglobinuric acute renal failure reveals continuous arterio-venous hemofiltration (CAVH) to have an effective clearance for myoglobin. Thus, the time until recovery of renal function as well as the frequency of secondary complications in rhabdomyolysis induced acute renal failure can be distinctly reduced.

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131I-meta-iodobenzylguanidine scanning was performed in 14 patients with phaeochromocytomas. In all but one patient scintigraphy successfully localized the lesion(s). The results confirm that scintigraphic imaging with 131I-meta-iodo-benzylguanidine, a noninvasive method, is a valid and reliable procedure for imaging and localization of adrenal and extra-adrenal phaeochromocytomas, both benign and malignant.