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PubMed1983

[A simple diagnostic test for primary hyperaldosteronism].

Plasma aldosterone levels were measured as part of two suppression tests in 31 hypertensive patients on normal sodium diet and without recent treatment. Thirteen patients had essential hypertension, 6 had probable bilateral adrenal hyperplasia and 12 had confirmed Conn's adenoma. In the first test, aldosterone levels were measured in the supine patients, then after infusion of 2 litres of isotonic saline over 2 hours. In the second test, aldosterone levels were measured before and 3 hours after oral administration of Captopril 1 mg/kg. Plasma aldosterone values superior to 360 pmol.l-1 after sodium load or to 665 pmol.l-1 after Captopril were characteristic of primary hyperaldosteronism due to adenoma. The test using Captopril has the advantages of being rapid, of avoiding acute blood volume expansion and of being applicable to all forms of hypertension, including severe ones.

Adrenal Glands↗
PubMed1982

[Spironolactone bodies. Light and electron microscope study apropos of 4 cases of adrenal adenomas with primary hyperaldosteronism].

So-called Spironolactone bodies are reported in four adrenal cortical adenomas that were removed from patients with primary hyperaldosteronism, treated preoperatively with spironolactone. Their morphology is described optically : these round acidophilic cytoplasmic bodies have a laminated appearance that ranges in size from 2 to 20 mu in diameter. Electron microscopy of the zona glomerulosa non adenomatous cells and of adenomatous cells of glomerular type reveals numerous membranes arranged concentrically around a central core. Connections between the endoplasmic reticulum and mitochondria in the cytoplasm of the cell and lining layers of the body are described and analysed. The authors attempt to explain the formation and the increase of the bodies. Correlations appear between the number of spironolactone bodies and duration of administration of spironolactone and total drug dosage. The results are discussed with those of the literature.

Adenoma↗
PubMed1983

[A new diagnostic test for primary tumoral hyperaldosteronism].

Plasma aldosterone levels were measured during two tests of inhibition in 31 hypertensive patients (13 essential hypertension, 6 bilateral adrenal hyperplasia and 12 documented Conn adenomas) on normal salt diets after withdrawal of all therapy: 1--before and after intravenous infusion of 2 I normal saline in two hours; 2--before and three hours after administration of 1 mg/kg of Captopril. Plasma aldosterone levels greater than 360 pmol/I after salt loading, or greater than 748 pmol/I after Captopril is characteristic of primary tumoral hyperaldosteronism. Apart from the rapidity of the test, Captopril is well-tolerated, does not require acute volume expansion and can be carried out in all forms of hypertension, even in severe cases.

Adenoma↗
PubMed1984

[Hyperaldosteronism in the acute phase of myocardial infarction. Effects of its treatment on the prevention of ventricular fibrillation].

Many metabolic and hormonal changes are observed during the acute phase of myocardial infarction (glucose metabolism, lipoproteins...). Mineralocorticoid function may also be disturbed but there have been few studies of this problem. The aim of this study was to confirm the elevation of serum aldosterone during the acute phase of myocardial infarction and to determine the effects of antialdosterone treatment in these patients. Hyperaldosteronism was confirmed in 74% of 72 consecutive patients admitted for acute myocardial infarction, in 85% if patients previously treated by an antialdosterone drug or admitted after the acute phase are excluded, and in 96% if patients with cardiac failure are included. One thousand consecutive patients admitted for myocardial infarction were given an antialdosterone agent systematically (intravenous potassium canrenoate , 600 mg daily for 5 days). The serum and red blood cell potassium concentrations rose, the number of ventricular extrasystoles and the administration of anti-arrhythmic drugs fell, and, above all, the prevalence of ventricular fibrillation decreased significantly: 0,8% (p less than 0,001), compared with comparable previously reported series.

Acute Disease↗
PubMed1983

[Aldosterone in primary hyperaldosteronism].

The conditions which must be respected to ensure the validity of the biochemical diagnostic criteria of primary hyperaldosteronism, conditions of blood sampling, timing posture and age of the patient, sodium intake and intercurrent drug therapy. As none of the tests is 100 p. 100 specific in distinguishing adrenal adenoma from hyperplasia, an association of several investigations has to be used. In cases of adenoma, the authors recommend the investigations which demonstrate the autonomy of secretion and the prevalence of circadian rhythm over the influence of change in posture. The measurement of aldosterone levels may be completed by that of its precursor, 18-hydroxy-corticosterone (18 OH CS).

Adenoma↗
PubMed1983

[Arterial hypertension with secondary hyperaldosteronism, reversible by nifedipine, in systemic scleroderma].

A case of severe hypertension with secondary hyperaldosteronism developing in a 71 year old woman affected by "Crest" syndrome is reported. The patient was treated by nifedipine, which led to the correction of blood pressure, plasma renin activity and serum aldosterone. The role of renal arteries vasospasm and renin-angiotension system in the genesis of scleroderma is discussed.

Aged↗
PubMed1983

[Morphology of the adrenal gland in primary hyperaldosteronism].

Between 1964 and 1980 25 patients (16 women and 9 men) underwent unilateral adrenalectomy for primary hyperaldosteronism at the Zurich University Hospital Department of Urology. In 17 cases (68%) review of the histological slides revealed adenoma, in 3 cases (12%) so-called idiopathic hyperplasia, and in one patient (4%) adrenal carcinoma. The histological features of these 21 cases were in keeping with the postoperative changes in blood pressure. However, in 4 patients (16%) the alterations of adrenal tissue could not be either correlated with the subsequent clinical course or satisfactorily classified without electron-microscopic and biochemical examination.

Adenoma↗
PubMed1980

[Surgical treatment of different forms of hyperaldosteronism with low renin activity in the blood plasma].

The clinical picture and biochemical values in patients with arterial hypertension and concomitant hyperaldosteronism and low renin activity in blood plasma due to adenoma of the adrenocortical glomerular zone and in its absence were studied before and after surgical treatment. An attempt is made to substantiate the expediency of surgical or nonoperative treatment of patients with aldosteroma or bilateral hyperplastic process in the adrenals.

Adrenal Cortex Neoplasms↗
PubMed1980

[The dopaminergic system and aldosterone secretion. I. Suppressive effects of L-dopa on secondary hyperaldosteronism].

The authors studied the blood aldosterone, cortisol and kalium levels, the plasma renin activity and the aldosterone urinary excretion following L-DOPA (0.50 g per os) administration in seven patients affected by hypertension and secondary hyperaldosteronism. The results suggest that L-DOPA administration, by stimulating the dopaminergic biosynthesis. Nevertheless such a conclusion needs further investigations.

Adult↗
PubMed1981

Hyperaldosteronism after heart surgery in children. Part II: Regulation of aldosterone secretion.

The relative importance of the various mechanisms responsible for development of postoperative hyperaldosteronism (HA) is not known. Therefore, serum sodium (NA), plasma-renin activity (PRA) and plasma cortisol (PC) were evaluated in pediatric patients with transient HA following heart surgery. PRA and PC were elevated and NA was depressed postoperatively. Plasma aldosterone (PA) was negatively correlated with NA (r = -0.77; p less than 0.001) and positively correlated with PRA (r = 0.68; p less than 0.01) but was not significantly correlated with PC. PRA and NA were significantly negatively correlated (r = 0.53; p less than 0.005). Multiple regression analysis revealed that NA had the strongest influence on PA, with PRA having a somewhat lesser but still significant influence; PC had no influence. Despite the significant negative correlation between PRA and NA, the interaction of the two variables in influencing PA was not significant (partial F-test; F = 0.12; p greater tha 0.5). It is concluded that in the postoperative state sodium depletion stimulates secretion of aldosterone not only via the angiotensin-renin system but also in a significant manner by a mechanism unrelated to the angiotensin-renin system. ACTH does not seem to play an important role in postoperative HA.

Adolescent↗
PubMed1982

Primary hyperaldosteronism: a pituitary--adrenal dysfunction related to a new pituitary glycopeptide?

A novel glycopeptide has been isolated from human and porcine pituitary glands. This substance is the amino-terminal fragment of pro-opiomelanocortin (POMC). The complete amino acid sequence has been determined. When tested for its steroid stimulating activity on an aldosterone secreting human adrenocortical adenoma, it was found to be more potent than angiotensin and ACTH. These results raise the interesting possibility that primary hyperaldosteronism could be related to a pituitary adrenal dysfunction.

Adenoma↗
PubMed1981

[Adrenocortical scintigraphy with 131I-19-iodocholesterol. Indications and results in 66 cases of hypercortisolism and hyperaldosteronism (author's transl)].

Scintigraphy was used in 66 patients with biochemically demonstrated hyperactivity of the adrenal cortex in order to determine the nature and site of the lesions. In cases of hypercortisolism, uptake was bilateral in 12 patients with Cushing's disease, unilateral in 7 patients with malignant or non-malignant tumours, and absent in 3 cases of large malignant tumours. In cases of hyperaldosteronism, scintigraphy performed during dexamethasone-induced ACTH suppression showed distinctly asymmetrical uptake in 13 patients with Conn's adenoma (confirmed by surgery as being on the good uptake side in 10 patients), symmetrical in 20 patients with biochemical findings indicating bilaterality, and intermediate in 9 patients. There was no false positive diagnosis of tumour. Scintigraphy appears to be of considerable value for locating adrenocortical lesions, especially small tumours.

19-Iodocholesterol↗
PubMed1981

[Diagnostic possibilities of computerized tomography in primary hyperaldosteronism (author's transl)].

In 20 patients with a clinical picture of primary hyperaldosteronism (5 patients were later found to be suffering from hypertension of other origin), CT showed diagnostic precision higher than 90% in the localization of adrenal adenoma (11 out of 12). On the other hand, this examination scarcely helped in the diagnosis of uncommon gland hyperplasias (1 out of 3). In CT doubtful or negative cases, hormonal measurement in blood samples taken selectively from adrenal veins was more indicative than selective phlebography. CT can therefore be considered as an alternative to iodocholesterol scintigraphy in early diagnostic investigation in this field of pathology.

Adenoma↗
PubMedDate not supplied

[Malignant tumour of adrenal with feminizing syndrome and primary hyperaldosteronism (author's transl)].

Feminizing tumour of adrenals are rare. Gynecomasty, abdominal tumour are the more frequently observed symptoms. The described case in a 38 years aged man is of special interest because of association with primary hyperaldosteronism. Studies in vivo and in vitro are reported. In vitro studies shown a high 18 hydroxylation biosynthetic activity of tumoral fragment and a great synthesis of polar phenolsteroids with testosterone as precurseurs.

Adrenal Cortex Neoplasms↗
PubMed1980

Hyperaldosteronism, hyperparathyroidism, medullary sponge kidneys, and hypertension.

Hyperparathyroidism and hyperaldosteronism coexisted in association with medullary sponge kidneys in a 27-year-old woman with severe hypertension. A modest fall in systolic and diastolic pressure followed removal of a parathyroid adenoma. Blood pressure was controlled with spironolactone therapy and restored to normal after removal of an aldosterone-secreting adrenal tumor. Elevated levels of aldosterone may have been responsible for the severe hypertension, while hypercalcemia may have had a synergistic effect on the arteriolar response to circulating vasoactive peptides.

Adenoma↗
PubMed1995

Dexamethasone-suppressible hyperaldosteronism: clinical, biochemical and genetic relations.

Clinical, biochemical and molecular data on five kindreds with dexamethasone-suppressible hyperaldosteronism are reviewed. The clinical phenotype varies from severe, early onset hypertension to much milder blood pressure elevation; hypokalaemia is usually mild. The genetic basis of the syndrome reflects the presence of a chimaeric gene derived from an unequal crossover between CYP11B1 and CYP11B2, resulting in ACTH-sensitive aldosterone synthase activity. In five kindreds, at least three different mutations have been identified, suggesting that allelic predisposition might lead to increased geographical prevalence of the condition in Celtic populations.

Adrenal Cortex Hormones↗
PubMed1994

[Primary hyperaldosteronism and adrenal tumors. Clinico-surgical experience with 9 patients].

PURPOSE: To report seven patients with diagnosis of primary aldosteronism, five of them due to aldosterone-producing adenoma (APA) and two due to idiopathic hyperaldosteronism (IHA), and two patients with adrenal non-producing tumors in order to discuss our experience on differential diagnosis and treatment of this hypertensive disease. METHODS: Hypokalemia and higher values of urinary potassium in the absence of diuretics were useful to the screening diagnosis of primary aldosteronism, reinforced by suppressed plasma renin activity either at rest and after deambulation and by higher values of plasma aldosterone. Computerized tomography in all patients and selenium-cholesterol scintigraphy were used to make the localization of tumors and differential diagnosis between APA and IHA. RESULTS: The patients with adrenal tumors were submitted to surgical treatment and the two patients with IHA were submitted to spironolacone therapy. After 1 to 5 years of follow-up, we observed cure of hypertension and hypokalemia in three patients after surgery and improvement of blood pressure control and normalization of serum potassium in the six others. CONCLUSION: The diagnosis of primary aldosteronism is important, besides its rarity, because surgical or appropriated clinical treatment provide cure of hypertension or improvement of blood pressure control in most of patients.

Adrenal Cortex Neoplasms↗