Primary Aldosteronism due to Unilateral Adrenal Microadenoma in an Elderly Patient: Efficacy of Selective Adrenal Venous Sampling

Tamura, Yoshiaki; Adachi, Jun Ichiro; Chiba, Yuko; Mori, Seijiro; Takeda, Kazuhiro; Kasuya, Yutaka; Murayama, Tadako; Sawabe, Motoji; Sasano, Hironobu; Araki, Atsushi; Ito, Hideki; Horiuchi, Toshiyuki

doi:10.2169/internalmedicine.47.0333

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…186,187 Primary aldosteronism prevalence varies from 1% to 11%, increases according to hypertension severity, 188 and cross-sectional and prospective studies report primary aldosteronism in Ͼ10% of patients with hypertension, 189 with approximately 70% caused by adrenal adenomas. 190 The adenoma is usually unilateral and comprised of glomerulosa cells in the adrenal cortex.…”

Section: Primary Aldosteronismmentioning

confidence: 99%

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

et al. 2011

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Section: Primary Aldosteronismmentioning

confidence: 99%

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

et al. 2011

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“…Although most cases are in younger patients, rare cases with primary aldosteronism in elderly patients have been reported (186,187). Primary aldosteronism prevalence varies from 1% to 11%, increases according to hypertension severity (188), and cross-sectional and prospective studies report primary aldosteronism in Ͼ10% of patients with hypertension (189), with approximately 70% caused by adrenal adenomas (190).…”

Section: Primary Aldosteronismmentioning

confidence: 99%

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

Aronow¹,

Fleg²,

Pepine³

et al. 2011

Journal of the American College of Cardiology

403

146

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“…36, 37, 38, 39 The diagnosis of microAPA, in our view, should be histopathologically confirmed in two ways; a micronodule should be detected by HE staining, and subsequently immunohistochemically examined for expression of steroidogenic enzymes. 8, 40 The requisite for diagnosis of a microAPA should include increased expression of 3β-HSD and attenuated or negative expression of P450c17 within the lesion, which can be further supported by the presence of ‘paradoxical hyperplasia', that is, suppressed or negative expression of 3β-HSD in the zona glomerulosa of the attached adrenal tissue.…”

Section: Discussionmentioning

confidence: 97%

Difficult-to-control hypertension due to bilateral aldosterone-producing adrenocortical microadenomas associated with a cortisol-producing adrenal macroadenoma

et al. 2010

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The patient was a 54-year-old woman who developed a right adrenal tumour, Cushingoid features, elevated levels of cortisol that were not suppressed by 1 nor 8 mg of dexamethasone, and suppression of adrenocorticotropin (ACTH) during treatment for severe hypertension. Computed tomography (CT) revealed a right adrenal tumour and an atrophic left adrenal gland. In addition, elevated plasma aldosterone concentration (PAC) and suppressed plasma renin activity (PRA) with an aldosterone-to-renin ratio of 128 (ng per 100 ml per ng ml–1 h−1) suggested aldosterone excess. Urinary excretion of aldosterone was relatively high, and the captopril and rapid ACTH tests resulted in no response of PRA and exaggerated increase in PAC, respectively. ACTH-loaded adrenal venous sampling showed bilateral excess of aldosterone with right predominance of cortisol. Right laparoscopic partial adrenalectomy (ADX) and immunohistochemical analysis showed both a cortisol-producing adenoma and an aldosterone-producing microadenoma (microAPA) within the attached adrenal, which had not been detected by CT preoperatively. After the right partial ADX, her blood pressure, aldosterone level and suppressed PRA remained unchanged. Subsequently, laparoscopic total left ADX was performed. Two microAPAs with paradoxical hyperplasia were revealed within the apparently atrophic left adrenal gland. Soon after the second surgery, her blood pressure normalized without requiring any anti-hypertensive medication.

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Primary Aldosteronism due to Unilateral Adrenal Microadenoma in an Elderly Patient: Efficacy of Selective Adrenal Venous Sampling

Abstract: We encountered a case of drug-resistant hypertension and hypokalemia. Laboratory data suggested primary aldosteronism (PA)

Cited by 12 publications

References 15 publications

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

Difficult-to-control hypertension due to bilateral aldosterone-producing adrenocortical microadenomas associated with a cortisol-producing adrenal macroadenoma

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