Abstract
A 11 y/o black boy with significant hypertension (160/100) demonstrated hyperaldosteronism and low renins unaffected by ACTH, dexamethasone or alterations in dietary sodium. With sodium restriction, dexamethasone and Aldactone administration, blood pressure decreased but ACTH did not increase blood pressure. The plasma volume was increased in baseline state. Plasma aldo was very elevated and unchanged throughout while plasma DOC which was normal, increased with ACTH and decreased with dexamethasone. There was no change in DOC with changes in dietary sodium. The high plasma aldo and the normal DOC concentrations demonstrate that abnormal steroidogenesis in this child is restricted to the usually renin-controlled adrenal glomerulosa while the ACTH regulated fasciculata is normal. Arteriography suggested bilateral nodular adrenal hyperplasia. Bilateral renal vein renins were very low. Bilateral adrenal vein aldosterone concentrations were very high. The hypertension appears to be dependent on vascular volume and responds to measures which cause natriuresis. This is a well-documented case of primary hyperaldosteronism due to bilateral adrenal hyperplasia in which the excessive aldosterone secretion appears to be independent of regulation by renin or ACTH. Further, the continued elevation of blood pressure despite decreased aldosterone with metyrapone administration suggests a hormone other than aldosterone is causing hypertension.
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Levine, L., Landau, P., Brook, M. et al. HYPERALDOSTERONISM DUE TO BILATERAL ADRENAL HYPERPLASIA INDEPENDENT OF RENIN OR ACTH REGULATION. Pediatr Res 9, 677 (1975). https://doi.org/10.1203/00006450-197508000-00076
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DOI: https://doi.org/10.1203/00006450-197508000-00076