Abstract | OBJECTIVE: To characterize the clinical and laboratory features of primary aldosteronism and to evaluate which diagnostic tests can discriminate surgically curable forms of this syndrome. DESIGN: RESULTS:
Drug therapy was discontinued before diagnostic tests were done in 56 of 82 patients (34 with adenomas and 22 with hyperplasia). Compared with patients with hyperplasia, those with adenomas had higher systolic (184 mm Hg and 161 mm Hg, respectively; P < 0.001) and diastolic blood pressures (112 mm Hg and 105 mm Hg; P = 0.03), lower serum potassium levels (3.0 mmol/L and 3.5 mmol/L; P < 0.001), and higher serum CO2 (P = 0.001), atrial natriuretic peptide (P = 0.008), and urinary 18-methyl oxygenated cortisol metabolite levels (P = 0.02). In patients with adenomas, aldosterone secretion lateralized to one adrenal gland and did not increase during the postural stimulation test; preoperative urinary aldosterone levels were correlated with diastolic pressures (r = 0.58; P = 0.001). Hypertension was "cured" postoperatively in approximately 35% of patients with adenomas and those with hyperplasia (P > 0.2) but was "improved" more frequently in those with adenomas (P = 0.002). Cured patients from both groups were younger than those not cured (mean ages, 43 years and 54 years, respectively; P = 0.002) and had lower preoperative mean plasma renin activity (0.17 ng/mL per hour and 0.50 ng/mL per hour; P < 0.001). All patients with adenomas in whom aldosterone secretion lateralized were either cured or improved. CONCLUSION:
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Authors | J D Blumenfeld, J E Sealey, Y Schlussel, E D Vaughan Jr, T A Sos, S A Atlas, F B Müller, R Acevedo, S Ulick, J H Laragh |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 121
Issue 11
Pg. 877-85
(Dec 01 1994)
ISSN: 0003-4819 [Print] United States |
PMID | 7978702
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Topics |
- Adenoma
(complications)
- Adrenal Gland Neoplasms
(complications)
- Adrenal Glands
(pathology)
- Adrenalectomy
- Algorithms
- Cardiovascular Diseases
(etiology)
- Female
- Humans
- Hyperaldosteronism
(diagnosis, etiology, metabolism, surgery)
- Hyperplasia
(complications)
- Hypertension
(etiology, surgery)
- Kidney Diseases
(complications)
- Male
- Middle Aged
- Retrospective Studies
- Treatment Outcome
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