Aldosterone producing adenoma: fludrocortisone suppression and left adrenal vein catheterisation in definitive diagnosis and management
Gordon, R.D.; Jackson, R.V.; Strakosch, C.R.; Tunny, T.J.; Rutherford, J.C.; Mccosker, J.; Moriarty, W.
Australian and New Zealand Journal of Medicine 9(6): 676-682
1979
ISSN/ISBN: 0004-8291 PMID: 294925 Document Number: 150978
In 12 (8 female) consecutive patients with primary aldosteronism (1971-1978), aged 15-54 yr, the diagnosis was unsuspected until hypokalemia (mean 2.2 mmol/l) was revealed by routine biochemical testing. In 9 patients, hypertension was severe (diastolic blood pressure > 120 mmHg, 7 patients on treatment). A firm diagnosis of primary aldosteronism was based on sequential demonstration of high urine K excretion with concurrent unexplained hypokalemia, inappropriately suppressed plasma renin activity after application of 2 potent stimuli to renin secretion, i.e., salt-free diet and upright posture, inappropriately high aldosterone production demonstrated by measurement of 24 h urine aldosterone excretion after 7 days of high salt diet and fludrocortisone acetate orally. Left adrenal vein catheterization, which is said to provide preoperative localization of aldosterone producing adenoma to the right or left gland and to distinguish aldosterone producing adenoma from bilateral hyperplasia of the zona glomerulosa, was successful in 10 of 12 patients. A left-sided adenoma was correctly predicted in 8, a right-sided adenoma in 1 and results consistent with bilateral hyperplasia were found in 1 patient. Right-sided adenomas were present in the 2 patients in whom adrenal vein catheterization was unsuccesful. After removal of the 11 adenomas, plasma K returned to normal and hypertension was cured in 9 patients and markedly improved in 2. The combination of 7 days of salt loading and fludrocortisone acetate to firmly establish the diagnosis, followed by adrenal venous catheterization to lateralize the tumor, leads to a high cure rate in the treatment of aldosterone producing adenoma.