The syndrome of primary aldosteronism produces few signs or symptoms. The diagnosis
should be suspected when either spontaneous hypokalemia or easily provoked hypokalemia
is found in a patient with hypertension. Hypokalemia in association with inappropriate
kaliuresis, low plasma renin activity, and a high plasma aldosterone concentration/plasma
renin activity ratio are the findings on initial screening tests that should suggest
primary aldosteronism. The diagnosis must be confirmed by demonstrating nonsuppressible
aldosterone excretion in conjunction with normal cortisol excretion. The choice of
therapy is based on distinguishing unilateral from bilateral adrenal disease. With
a unilateral adrenal adenoma, surgical removal reverses the hypokalemia and frequently
cures the hypertension. In most patients with bilateral adrenal hyperplasia who are
treated surgically, however, hypertension persists; thus, the initial treatment in
these patients should be pharmacologic.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Presidential address: Part I. Painting background. Part II. Primary aldosteronism, a new clinical syndrome.J Lab Clin Med. 1955; 45: 3-17
- Spontaneous hypopotassemia, hypomagnesemia, alkalosis and tetany due to hypersecretion of corticosterone-like mineralocorticoid.Am J Med. 1955; 19: 976-988
- Primary aldosteronism: diagnostic evaluation.Endocrinol Metab Clin North Am. June 1988; 17: 367-395
- New types of primary aldosteronism (abstract).Clin Res. 1988; 36: 123A
- Primary adrenal hyperplasia: a new subset of primary hyperaldosteronism.J Clin Endocrinol Metab. 1984; 58: 783-785
- Aldosterone-producing adenomas responsive to angiotensin pose problems in diagnosis.Clin Exp Pharmacol Physiol. 1987; 14: 175-179
- Heterotopic adrenocortical adenoma producing primary aldosteronism.J Urol. 1967; 98: 133-139
- Primary aldosteronism due to a malignant ovarian tumor.J Clin Endocrinol Metab. 1975; 41: 809-819
- Prevalence of primary aldosteronism.Acta Med Scand Suppl. 1981; 646: 54-57
- Reliability of screening methods for the diagnosis of primary aldosteronism.Am J Med. 1979; 67: 403-413
- A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity.Arch Intern Med. 1981; 141: 1589-1593
- Primary aldosteronism.Kidney Int. 1984; 26: 769-778
- New insights into the medical management of primary aldosteronism.Hypertension. 1986; 8: 76-82
- Clinical implications of primary aldosteronism with resistant hypertension.Hypertension. 1988; 11: I207-I211
- A case of normotensive primary aldosteronism—comparison with 13 previously experienced cases with hypertension.Endocrinol Jpn. 1984; 31: 159-164
- Double blind control study of antihypertensive agents. III. Chlorothiazide alone and in combination with other agents: preliminary results.Arch Intern Med. 1962; 110: 230-236
- Incidence of primary aldosteronism uncomplicated “essential” hypertension: a prospective study with elevated aldosterone secretion and suppressed plasma renin activity used as diagnostic criteria.JAMA. 1968; 205: 497-502
- Primary aldosteronism: diagnosis, localization, and treatment.Ann Intern Med. 1979; 90: 386-395
- The changing clinical spectrum of primary aldosteronism.Am J Med. 1983; 74: 641-651
- Plasma renin activity in the diagnosis of primary aldosteronism: failure to distinguish primary aldosteronism from essential hypertension.Arch Intern Med. 1969; 123: 141-146
- Plasma aldosterone-plasma renin activity ratio: a simple test to identify patients with primary aldosteronism.Acta Endocrinol (Copenh). 1986; 113: 564-569
- Is single oral administration of captopril beneficial in screening for primary aldosteronism?.Am Heart J. 1986; 112: 361-367
- Is aldosterone/renin ratio useful to screen a hypertensive population for primary aldosteronism?.Clin Exp Pharmacol Physiol. 1985; 12: 249-252
- Adrenergic activity and aldosterone regulation: no evidence for an alpha-1 adrenoceptor-mediated influence in normal subjects.Clin Endocrinol. 1986; 25: 87-95
- Effect of guanethidine and of reserpine on angiotensin responsiveness in man.Int J Clin Pharmacol Biopharm. 1975; 11: 35-39
- Use of the saline infusion test to diagnose the cause of primary aldosteronism.Am J Med. 1985; 79: 722-728
- Single dose captopril as a diagnostic test for primary aldosteronism.J Clin Endocrinol Metab. 1983; 57: 892-896
- Diagnostic value of a single dose of captopril in renin- and aldosterone-dependent, surgically curable hypertension.Cardiovasc Rev Rep. 1982; 11: 1659-1667
- Mineralocorticoids.in: Donald RA Endocrine Disorders: A Guide to Diagnosis. Marcel Dekker, New York1984: 371-401
- Identification and differentiation of surgically correctable hypertension due to primary aldosteronism.Am J Med. 1979; 67: 397-402
- Primary aldosteronism with normal aldosterone levels in blood and urine.Acta Endocrinol (Copenh). 1985; 110: 522-525
- Effect of aging on renin activity and aldosterone excretion.J Lab Clin Med. 1976; 87: 947-959
- Aging and aldosterone.Am J Med. 1983; 74: 442-448
- Diagnosis and localization of aldosterone-producing adenomas by adrenal-vein catheterization.N Engl J Med. 1967; 277: 1050-1056
- Adrenal arteriography and venography in primary aldosteronism.Radiology. 1971; 101: 71-78
- Primary aldosteronism: experience with thirty-eight patients.Surgery. 1979; 86: 470-473
- Location of aldosterone-producing adenomas with 131I-19-iodocholesterol.N Engl J Med. 1976; 294: 410-414
- A new and superior adrenal imaging agent, 131I-6ß-iodomethyl-19-nor-cholesterol (NP-59): evaluation in humans.J Clin Endocrinol Metab. 1977; 45: 353-362
- Detection of adrenal tumors by computerized tomographic scan in endocrine hypertension.Arch Intern Med. 1979; 139: 589-590
- Primary hyperaldosteronism: comparison of CT, adrenal venography, and venous sampling.AJR. 1983; 141: 299-302
- Primary aldosteronism: changing concepts in diagnosis and management.Am J Surg. 1986; 152: 116-121
- Use of computed tomography in diagnosing the cause of primary aldosteronism.N Engl J Med. 1980; 303: 1503-1507
- Preoperative localization of aldosterone-producing adenomas: an analysis of the efficiency of different diagnostic procedures made from 11 cases and from a review of the literature.Acta Med Scand. 1980; 208: 101-109
- Evolution of the surgical management of primary aldosteronism.Ann Surg. 1980; 191: 1-7
- Localization of aldosterone-producing adenoma by computed tomography.J Clin Endocrinol Metab. 1979; 49: 642-645
- Primary aldosteronism: clinical management.Arch Surg. 1984; 119: 585-590
- Anomalous postural response of plasma aldosterone concentration in patients with aldosterone-producing adrenal adenoma.J Clin Endocrinol Metab. 1973; 36: 401-404
- The prediction of anatomical morphology of primary aldosteronism using serum 18-hydroxycorticosterone levels.J Clin Endocrinol Metab. 1985; 60: 67-73
- The management of patients with primary aldosteronism.World J Surg. 1982; 6: 757-764
- Severe hypertension in primary aldosteronism and good response to surgery.Lancet. 1979; 1: 482-485
- Fifty cases of primary hyperaldosteronism in Hong Kong Chinese with a high frequency of periodic paralysis: evaluation of techniques for tumour localisation.Q J Med. 1986; 61: 1021-1037
- The blood pressure response to unilateral adrenalectomy in primary aldosteronism.Q J Med. 1986; 61: 1141-1151
- The diagnosis of primary hyperaldosteronism.Lancet. 1981; 1: 120-125
- Computed tomography versus ultrasound of the adrenal gland: a prospective study.Radiology. 1982; 143: 121-128
- Effect of posture on the metabolic clearance rate, plasma concentration and blood production rate of aldosterone in man.J Clin Endocrinol Metab. 1968; 28: 1630-1640
- Primary aldosteronism: computerized tomography in preoperative evaluation.South Med J. 1985; 78: 1071-1073
- Plasma aldosterone concentration: further characterization of aldosterone-producing adenomas.Circ Res. 1974; 34: I183-I189
- Adrenal aldosterone-producing adenoma: use of colonic potential in diagnosis and subtraction scanning technique for localisation.Br Med J. 1976; 2: 11-14
- Primary aldosteronism: photoscanning of tumors after administration of 131I-19-iodocholesterol.Arch Intern Med. 1972; 129: 417-425
- I-19-iodocholesterol scintigraphy of the adrenal cortex.Acta Endocrinol (Copenh). 1975; 80: 81-94
- Localization of functional adrenal tumors by computed tomography and venous sampling.Radiology. 1982; 142: 429-433
- Adrenal venography and sampling in the diagnosis and treatment of primary aldosteronism.N Z Med J. 1976; 83: 313-316
- Comparative study of diagnosis for location of adrenal adenoma in patients with primary aldosteronism.Folia Endocrinol Jpn. 1976; 52: 1046-1052
- The value of scintigraphy and computed tomography for the differential diagnosis of primary hyperaldosteronism.Acta Endocrinol (Copenh). 1986; 113: 118-122
- Diagnosis and localization in primary aldosteronism.Ann Intern Med. 1972; 76: 885-890
- Adrenal vein epinephrine levels: a useful aid in venous sampling for primary aldosteronism.Ann Intern Med. 1982; 97: 690-693
- Preoperative differentiation of adrenal adenoma from idiopathic adrenal hyperplasia in primary aldosteronism.Circ Res. 1974; 34: I175-I182
- Computed tomography and scintigraphy of aldosteronoma: a comparative study.Clin Nucl Med. 1983; 8: 610-612
- Pre-operative localization of aldosterone-secreting adrenal adenomas.Clin Endocrinol (Oxf). 1981; 15: 593-606
- Adrenal venography: clinical-roentgenographic correlation in 80 patients.Am J Roentgenol Rad Ther Nucl Med. 1973; 119: 564-575
- Circadian rhythm and effect of posture on plasma aldosterone concentration in primary aldosteronism.J Clin Endocrinol Metab. 1976; 43: 115-131
- Adrenal imaging with 131I-19-iodocholesterol in the diagnostic evaluation of patients with aldosteronism.J Clin Endocrinol Metab. 1976; 42: 41-51
- Primary aldosteronism: diagnosis and noninvasive lateralization procedures.Cardiology. 1985; 72: 57-63
- Radiology in primary hyperaldosteronism.Am J Roentgenol. 1976; 127: 761-767
- Complications of adrenal venography.Br J Radiol. 1970; 43: 531-533
- Computed tomography scanning versus radioisotope imaging in adrenocortical diagnosis.Am J Med. 1983; 75: 653-657
- CT of the adrenal cortex.Semin Ultrasound CT MR. 1985; 6: 241-260
- Primary aldosteronism due to bilateral nodular hyperplasia: CT demonstration.J Comput Assist Tomogr. 1985; 9: 1125-1127
- Primary aldosteronism with bilateral adrenal adenomas.Virchows Arch [A]. 1980; 388: 229-236
- The adrenal cortex.in: Bloodworth Jr, JMB Endocrine Pathology: General and Surgical. Second edition. Williams & Wilkins, Baltimore1982: 419-471
- On the prevalence of adrenocortical adenomas in an autopsy material in relation to hypertension and diabetes.Acta Med Scand. 1968; 184: 211-214
- Non-functioning adrenal adenomas discovered incidentally on computed tomography.Radiology. 1983; 148: 495-499
- The incidentally discovered adrenal mass.Ann Intern Med. 1983; 98: 940-945
- MR imaging of the adrenals: correlation with computed tomography.J Comput Assist Tomogr. 1986; 10: 242-253
- The plasma aldosterone response to angiotensin II infusion in aldosterone-producing adenoma and idiopathic hyperaldosteronism.J Clin Endocrinol Metab. 1981; 52: 195-198
- Anomalous postural aldosterone response in glucocorticoid-suppressible hyperaldosteronism.N Engl J Med. 1981; 305: 991-993
- 18-Hydroxycorticosterone: a review.J Steroid Biochem. 1978; 9: 273-286
- Results of adrenal surgery in patients with hypertension, aldosterone excess, and low plasma renin concentration.Br Med J. 1975; 1: 135-138
- The intercurrent hypertension of primary aldosteronism.Circ Res. 1970; 27: I195-I202
- The syndrome of primary aldosteronism.Am J Med. 1970; 48: 343-356
- Adrenalectomy in primary aldosteronism: a long-term follow-up study.Cardiology. 1985; 72: 107-116
- Adrenalectomy: anterior or posterior approach?.Am J Surg. 1982; 144: 322-324
- The evolution of primary aldosteronism: 1954–1967.Harvey Lect. 1967; 62: 257-291
- Idiopathic aldosteronism: diagnostic artifact? (letter to the editor).Lancet. 1980; 1: 1422
- Current achievements and challenges in adrenal surgery.Br J Surg. 1984; 71: 983-985
- Primary aldosteronism: a follow-up study of 28 cases of surgically treated aldosterone-producing adenomas.Acta Med Scand. 1987; 221: 275-282
- Surgical management of aldosterone-producing adrenal adenomas: a review of 16 patients.Am J Surg. 1981; 142: 89-95
- Therapeutic effect of calcium channel blockade in primary aldosteronism.J Clin Endocrinol Metab. 1985; 60: 896-899
- Calcium channel blockade with nifedipine in primary aldosteronism.Hypertension. 1986; 8: I191-I194
- Effect of verapamil on aldosterone secretion in primary aldosteronism.J Endocrinol Invest. 1987; 10: 491-494
- The therapeutic effect of a new angiotensin-converting enzyme inhibitor, enalapril maleate, in idiopathic hyperaldosteronism (abstract).Clin Res. 1983; 31: 271A
Article info
Footnotes
Individual reprints of this article are not available. The entire Symposium on Hypertension will be available for purchase as a bound booklet from the Proceedings Circulation Office in February.
Identification
Copyright
© 1990 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
