Primary aldosteronism: difference in clinical presentation and long-term follow-up between adenoma and bilateral hyperplasia of the adrenal glands

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.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney

“…Others have claimed reliable discrimination of APA from BAH by demonstrating greater suppressibility of aldosterone levels in the latter subtype following extracellular volume expansion (539). However, the degree of suppression varies within the subtype in the individual patient (185,248,544,554). A clinical prediction score developed by Küpers et al (271), who reported presence of a unilateral mass lesion on CT "typical" for APA plus a serum potassium of Ͻ3.5 mM or an estimated glomerular filtration rate of at least 100 ml·min…”

Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension

“…To estimate the proportion of APA among patients with PA, we selected papers reporting diagnostic tests for PA and at least 50 patients with definite PA. To avoid an indication bias, we excluded surgical series in which all patients had been operated on. Among the nine eligible reports sorted by publication date in Table 2 [5,7,25,[28][29][30][31][32][33], the proportions of APA among patients with PA ranged from 24.2 to 77.4%, with an average of 56.6%. Finally, to estimate the frequency of hypertension cure or improvement following surgery, we analyzed series from single centres reporting postoperative BP follow-up in at least 50 patients with PA [34][35][36][37][38][39].…”

Multiple Sampling from the Central Veins with their Tributaries can Detect Bilateral Hyperaldosteronism with a Cortisol-Producing Adenoma in a Hypertensive Patient

“…Pathologically, adrenal glands in IHA are characterized by diffuse hyperplasia involving cells that resemble those found in the normal zona glomerulosa without nodules [15]. However, most IHA cases are treated with non-surgical methods because unilateral adrenalectomy has been considered ineffective [16]. Therefore, there is insufficient pathological information about IHA.…”