Abstract
Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a form of surgically curable secondary hypertension, and distinguishing APA from idiopathic hyperaldosteronism (IHA) is important for treatment. We made a differential diagnosis between APA and IHA using imaging tests such as adrenal CT and MRI as well as adrenal venous sampling (AVS) in all 93 cases of PA presenting at our institutions over the last decade. We identified 27 patients with aldosterone-producing microadenoma (APmicroA), all of whom could be diagnosed by AVS but not by the imaging tests. Then, we compared the clinical and roentgenological findings of these 27 patients with those of 42 patients with aldosterone-producing macroadenoma (APmacroA) and of 24 patients with IHA. Using surgically removed adrenal tissues, histopathological examinations and immunohistochemical analyses of steroidogenic enzymes were conducted. The findings for APmicroA were similar to those for APmacroA, except with respect to the diameter of the adrenal adenomas. Endocrinological and roentgenological findings for APmicroA were similar to those for IHA, but not to those for APmacroA. The rate of cure of hypertension was much greater in patients with APmicroA than in patients with APmacroA after the unilateral adrenalectomy (odds ratio, 4.0; p=0.028). In conclusion, it is important to accurately diagnose APmicroA, in which the laterality of the hyperproduction of aldosterone is only detectable by AVS, and to treat these patients by unilateral adrenalectomy in order to avoid long-term medical treatment and prevent hypertensive vascular complications.
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Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC : High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 1994; 21: 315–318.
Komiya I, Yamada T, Takasu N, et al: An abnormal sodium metabolism in Japanese patients with essential hypertension, judged by serum sodium distribution, renal function and the renin-aldosterone system. J Hypertens 1997; 15: 65–72.
Lim PO, Dow E, Brennan G, Jung RT, MacDonald TM : High prevalence of primary aldosteronism in the Tayside hypertension clinic population. J Hum Hypertens 2000; 14: 311–315.
Fardella CE, Mosso L, Gómez-Sánchez C, et al: Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology. J Clin Endocrinol Metab 2000; 85: 1863–1867.
Loh KC, Koay ES, Khaw MC, Emmanuel SC, Young WF Jr : Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab 2000; 85: 2854–2859.
Rossi E, Regolisti G, Negro A, Sani C, Davoli S, Perazzoli F : High prevalence of primary aldosteronism using postocaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives. Am J Hypertens 2002; 15: 896–902.
Conn JW : Primary aldosteronism, a new clinical syndrome. J Lab Clin Med 1955; 45: 3–17.
Van Buchem FSP, Doorenbos H, Elings HS : Primary aldosteronism due to adrenocortical hyperplasia. Lancet 1956; 271: 335–337.
Ross EJ : Conn's syndrome due to adrenal hyperplasia with hypertrophy of zona glomerulosa, relieved by unilateral adrenalectomy. Am J Med 1965; 39: 994–1002.
Banks WA, Kastin AJ, Biglieri EG, Ruiz AE : Primary adrenal hyperplasia: a new subset of primary hyperaldosteronism. J Clin Endocrinol Metab 1984; 58: 783–785.
Foye LV Jr, Feichtmeir TV : Adrenal cortical carcinoma producing solely mineralocorticoid effect. Am J Med 1955; 19: 966–975.
Sutherland DJA, Ruse JL, Laidlaw JC : Hypertension, increased aldosterone secretion and low plasma renin activity relieved by dexamethasone. Can Med Assoc J 1966; 95: 1109–1119.
Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Finn WL, Krek AL : Clinical and pathological diversity of primary aldosteronism including a new familiar variety. Clin Exp Pharmacol Physiol 1991; 18: 283–286.
Omura M, Sasano H, Fujiwara T, Yamaguchi K, Nishikawa T : Unique cases of unilateral hyperaldosteronism due to multiple adrenocortical micronodules, which can only be detected by selected adrenal venous sampling. Metabolism 2002; 51: 350–355.
Weinberger MH, Grim CE, Hollifield JW, et al: Primary aldosteronism. Ann Intern Med 1979; 90: 386–395.
Ganguly A : Primary aldosteronism. New Engl J Med 1998; 339: 1828–1834.
Stewart PM : Mineralocorticoid hypertension. Lancet 1999; 353: 1341–1347.
Lim PO, Young WF, MacDonald TM : A review of the medical treatment of primary aldosteronism. J Hypertens 2001; 19: 353–361.
Doppman JL, Gill JR Jr : Hyperaldosteronism: sampling the adrenal veins. Radiology 1996; 198: 309–312.
Young WF Jr, Stanson AW, Grant CS, Thompson GB, van Heerden JA : Primary aldosteronism: adrenal venous sampling. Surgery 1996; 120: 913–920.
Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T : Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 2004; 27: 193–202.
Naomi S, Iwaoka T, Umeda T, et al: Clinical evaluation of captopril screening test for primary aldosteronism. Jpn Heart J 1985; 26: 549–556.
Sasano H : Localization of steroidogenic enzymes in adrenal cortex and its disorders. Endocr J 1994; 41; 471–482.
Young WF Jr : Minireview: primary aldosteronism-changing concepts in diagnosis and treatment. Endocrinology 2003; 144: 2208–2213.
Mulatero P, Stowasser M, Loh KC, et al: Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004; 89: 1054–1050.
Rossi GP, Sacchetto A, Chiesura-Corona M, et al: Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab 2001; 86: 1083–1090.
Strauch B, Zelinka T, Hampf M, et al: Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the central Europe region. J Hum Hypertens 2003; 17: 349–352.
Stowasser M, Gordon RD, Gunasekera TG, et al: High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non-selective’ screening of hypertensive patients. J Hypertens 2003; 21: 2149–2157.
Noth RH, Biglieri EG : Primary hyperaldosteronism. Med Clin North Am 1988; 72: 1117–1131.
Sheaves R, Goldin J, Reznek RH, et al: Relative value of computed tomography scanning and venous sampling in establishing the cause of primary aldosteronism. Eur J Endocrinol 1996; 134: 308–313.
Stowasser M : Primary aldosteronism: rare bird or common cause of secondary hypertension? Curr Hypertens Rep 2001; 3: 230–239.
Magill SB, Raff H, Shaker JL, et al: Comparison of adrenal vein sampling and computed tomography in the differentiation of primary aldosteronism. J Clin Endocrinol Metab 2001; 86: 1066–1071.
Veglio F, Morello F, Rabbia F, et al: Recent advances in diagnosis and treatment of primary aldosteronism. Minerva Med 2003; 94: 259–265.
Phillips JL, Walther MM, Pezzullo JC, et al: Predictive value of preoperative tests in discriminating bilateral adrenal hyperplasia from an aldosterone-producing adrenal adenoma. J Clin Endocrinol Metab 2000; 85: 4526–4533.
Young WF Jr, Stanson AW, Thompson GB, et al: Role for adrenal venous sampling in primary aldosteronism. Surgery 2004; 136: 1227–1235.
Sawka AM, Young WF Jr, Thompson GB, et al: Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001; 135: 258–261.
Blumenfeld JD, Sealey JE, Schlussel H, et al: Diagnosis and treatment of primary aldosteronism. Ann Intern Med 1994; 121: 877–885.
Fukudome Y, Fujii K, Arima H, et al: Discriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy. Hypertens Res 2002; 25: 11–18.
Rossi GP, Sacchetto A, Paven E, et al: Remodeling of the left ventricle in primary aldosteronism due to Conn's adenoma. Circulation 1997; 95: 1471–1478.
Schmidt BM, Schmieder RE : Aldosterone-induced cardiac damage: focus on blood pressure independent effects. Am J Hypertens 2003; 16: 80–86.
Sato A, Saruta T : Aldosterone-induced organ damage: plasma aldosterone level and inappropriate salt status. Hypertens Res 2004; 27: 303–310.
Takeda Y : Pleiotropic action of aldosterone and the effects of eplerenone, a selective mineralocorticoid receptor antagonist. Hypertens Res 2004; 27: 781–789.
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Omura, M., Sasano, H., Saito, J. et al. Clinical Characteristics of Aldosterone-Producing Microadenoma, Macroadenoma, and Idiopathic Hyperaldosteronism in 93 Patients with Primary Aldosteronism. Hypertens Res 29, 883–889 (2006). https://doi.org/10.1291/hypres.29.883
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DOI: https://doi.org/10.1291/hypres.29.883
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