TITLE

Aldosterone-producing adenoma and other surgically correctable forms of primary aldosteronism

AUTHOR(S)
Amar, Laurence; Plouin, Pierre-Fran├žois; Steichen, Olivier
PUB. DATE
January 2010
SOURCE
Orphanet Journal of Rare Diseases;2010, Vol. 5, p9
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Surgically correctable forms of primary aldosteronism are characterized by unilateral aldosterone hypersecretion and renin suppression, associated with varying degrees of hypertension and hypokalemia. Unilateral aldosterone hypersecretion is caused by an aldosterone-producing adenoma (also known as Conn's adenoma and aldosteronoma), primary unilateral adrenal hyperplasia and rare cases of aldosterone-producing adrenocortical carcinoma. In these forms, unilateral adrenalectomy can cure aldosterone excess and hypokalemia, but not necessarily hypertension. The prevalence of primary aldosteronism in the general population is not known. Its prevalence in referred hypertensive populations is estimated to be between 6 and 13%, of which 1.5 to 5% have an aldosterone-producing adenoma or primary unilateral adrenal hyperplasia. Taking into account referral biases, the prevalence of surgically correctable primary aldosteronism is probably less than 1.5% in the hypertensive population and less than 0.3% in the general adult population. Surgically correctable primary aldosteronism is sought in patients with hypokalemic, severe or resistant forms of hypertension. Recent recommendations suggest screening for primary aldosteronism using the aldosterone to renin ratio. Patients with a raised ratio then undergo confirmatory suppression tests. The differential diagnosis of hypokalemic hypertension with low renin includes mineralocorticoid excess, with the mineralocorticoid being cortisol or 11-deoxycorticosterone, apparent mineralocorticoid excess, pseudo-hypermineralocorticoidism in Liddle syndrome or exposure to glycyrrhizic acid. Once the diagnosis is confirmed, adrenal computed tomography is performed for all patients. If surgery is considered, taking into consideration the clinical context and the desire of the patient, adrenal vein sampling is performed to detect whether or not aldosterone hypersecretion is unilateral. Laparoscopic surgery for unilateral aldosterone hypersecretion is associated with a morbidity of about 8%, with most complications being minor. It generally results in the normalization of aldosterone secretion and kalemia, and in a large decrease in blood pressure, but normotension without treatment is only achieved in half of all cases. Normotension following adrenalectomy is more frequent in young patients with recent hypertension than in patients with longstanding hypertension or a family history of hypertension.
ACCESSION #
51988410

 

Related Articles

  • Primary aldosteronism.  // British Medical Journal;3/8/1980, Vol. 280 Issue 6215, p667 

    Examines the relation of primary aldosteronism to hypertension. Effect of hyperactivity of the adrenal adenoma; Mechanism of hypertension in primary aldosteronism; Presence of serum potassium concentrations in patients with the disease; Prevalence of hypokalemia in hypertensive patients.

  • Is it Possible to Extirpate Cardiovascular Events in Primary Aldosteronism after Surgical Treatment. Nishikawa, Tetsuo; Matsuzawa, Yoko; Saito, Jun; Omura, Masao // Japanese Clinical Medicine;2010, Issue 1, p21 

    It is well known that primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a surgically curable secondary hypertension. Thus, the differential diagnosis between unilateral hyperaldosteronemia due to APA and bilateral hyperaldosteronemia due to idiopathic hyperaldosteronism...

  • An occult aldosterone-producing adenoma initially presenting as hyperosmolar hyperglycaemic state. Feng-Chih Kuo; Yi-Jen Hung; Chang-Hsun Hsieh; Fone-Ching Hsiao // Annals of Clinical Biochemistry;Sep2012, Vol. 49 Issue 5, p505 

    Aldosterone-producing adenoma (APA), one of the most common causes of primary hyperaldosteronism, is clinically characterized by hypertension, increased sodium retention, increased potassium excretion and altered glucose metabolism. APA can also manifest in the form of hyperosmolar...

  • Persistent Hypokalaemia in a Jamaican Hypertensive Patient. Potu, C.; Mohammed, H.; Tulloch-Reid, M. K. // West Indian Medical Journal;Dec2011, Vol. 60 Issue 6, p674 

    We report the case of a 48-year old man with uncontrolled hypertension and persistent hypokalaemia from an aldosterone producing adrenal adenoma treated by laparoscopic adrenalectomy. Clinicians' identification of primary hyperaldosteronism is critical as the correct treatment results in...

  • Conn's syndrome due to a renin-responsive adrenal adenoma. Miles, S.M.; Moult, P.J.A.; Hoffbrand, B.I. // Journal of the Royal Society of Medicine;May1993, Vol. 86 Issue 5, p294 

    Primary aldosteronism was first described in 1955 by Conn and is characterized by the findings of hypertension, hypokalaemia, suppressed plasma renin activity and increased aldosterone production. The incidence is estimated at between 0.05% to 2% of all cases of hypertension. There are four main...

  • Adrenocortical carcinoma initially presenting with hypokalemia and hypertension mimicking hyperaldosteronism: a case report. Chun-Jui Huang; Ti-Hao Wang; Yuan-Hao Lo; Kuan-Ting Hou; Justin Ging-Shing Won; Tjin-Shing Jap; Chin-Sung Kuo // BMC Research Notes;2013, Vol. 6 Issue 1, p1 

    Background Adrenocortical carcinoma is a rare malignancy and rare cause of Cushing's syndrome. Case presentation A 65-year-old seemingly well male patient was referred to our clinic under the suspicion of hyperaldosteronism due to hypertension combined with hypokalemia. However, his serum...

  • Long-Term Results of Adrenalectomy in Patients with Aldosterone-Producing Adenomas: Multivariate Analysis of Factors Affecting Unresolved Hypertension and Review of the Literature. Lumachi, Franco; Ermani, Mario; Basso, Stefano M. M.; Armanini, Decio; Iacobone, Maurizio; Favia, Gennaro // American Surgeon;Oct2005, Vol. 71 Issue 10, p864 

    The long-term surgical cure rate of patients with primary aldosteronism varies widely, and causes of persistent hypertension are not completely established. We reviewed retrospectively charts from 98 patients (range, 19-70 years old) with aldosterone-producing adenomas who underwent unilateral...

  • Aldosteronoma causing Conn's syndrome: a case report and literature review. Hsin-Hui Shao; Hock-Liew Eng; Wen-Sheng Huang; Nybo Lin, Joseph // Health (1949-4998);Dec2009, Vol. 1 Issue 4, p269 

    We report a case of primary aldosteronism caused by bilateral solitary aldosteronomas occurring 6 months apart, the diagnosis being confirmed by clinical features. Multiple aldosterone- producing adenomas can be unilateral or bilateral. If bilateral, most of them are found simultaneously....

  • Pancreatic Tumors in Multiple Endocrine Neoplasia Type 1. Doherty, Gerard // World Journal of Surgery;May2006, Vol. 30 Issue 5, p663 

    The article focuses on the results of unilateral adrenalectomy in patients with aldosterone-producing adenoma or unilateral primary adrenal hyperplasia. Adrenal venous sampling is the reference standard test to differentiate unilateral from bilateral disease in patients with primary...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics