Secondary hyperaldosteronism (Bartter's syndrome) mimicking psychiatric illness.
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Fourteen patients with sickle cell anemia, ages 6 to 20 years, were studied while ingesting high- and low-sodium diets. Although none of the patients had excessive urinary loss of sodium, the majority had elevated plasma renin activities and aldosterone secretion rates. The PRA was higher in patients over 10 years of age; ASR in patients receiving the high-sodium diet increased with age. Patients with sickle cell anemia appeared to compensate for urinary sodium loss between crises. The mechanism of this loss could be a defect in the function of either the distal tubule or the loop of Henle.
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The major etiologies of primary aldosteronism are aldosterone-producing adrenal adenoma, requiring a surgical treatment, and bilateral hyperplasia, usually managed with medical therapy. We only report a retrospective study on 22 patients with primary aldosteronism diagnosed by clinical and usual biochemical tests. All the patients were explored by computed tomography scan (CT) and iodomethyl-norcholesterol scintigraphy. The purpose of this study was to compare the capacity of the two methods to differentiate adrenal adenoma and hyperplasia. The CT scan was more sensitive (sensitivity: 88%) compare to scintigraphy (sensitivity: 64%) for the diagnosis of adrenal adenoma. However, the scintigraphy was a useful tool to detect asymmetric macronodular adrenal hyperplasia. Therefore, the catheterisation of adrenal venous would be only necessary for a few cases. We conclude from this study and the literature review that CT scan and iodomethyl-norcholesterol scintigraphy are complementary and both useful to increase diagnostic reliability of primary aldosteronism.
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