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Primary hyperaldosteronism due to adrenal microadenoma: a curable cause of refractory hypertension

Department of Clinical Pharmacology, Addenbrooke's Hospital, Cambridge, ksm31{at}medschl.cam.ac.uk

Michaela Watts

Department of Clinical Pharmacology, Addenbrooke's Hospital, Cambridge

Derris S Appleton

Radiology, Addenbrooke's Hospital, Cambridge

David J Lomas

Radiology, Addenbrooke's Hospital, Cambridge

Neville Jamieson

Surgery, Addenbrooke's Hospital, Cambridge

Kevin P Taylor

Biochemistry, Addenbrooke's Hospital, Cambridge

Stuart Coghill

Histopathology, Addenbrooke's Hospital, Cambridge

Morris J Brown

Department of Clinical Pharmacology, Addenbrooke's Hospital, Cambridge

The diagnosis of primary hyperaldosteronism due to microadenoma or unilateral adrenal hyperplasia can be challenging, since hypokalaemic alkalosis, high plasma aldosterone and a definite adenoma on imaging may all be absent.

Method and result. We describe three cases of resistant hypertension (on > 5 antihypertensives) where hyperaldosteronism was suspected because of a suppressed plasma renin level despite treatment with multiple drugs which normally elevate renin. Renin mass was measured by a double-site chemi-immunoluminometric assay. All patients had normal plasma aldosterone levels. Hypokalaemia was present in the first two cases but computed tomography did not show clear cut adenomas.Adrenal vein sampling (AVS) revealed lateralisation (> 4 times higher aldosterone to cortisol ratio (ACR) on the affected than contra-lateral side).The third patient was normokalaemic and AVS showed only minimal lateralisation (ACR 1.3:1).The severe hypertension in all cases was reversed by adrenalectomy, with blood pressure falling to target despite withdrawal of all but one to two drugs.

Conclusions. The robotic assay of renin mass permits rapid detection of patients in whom plasma renin is suppressed below the normal range. A suppressed plasma renin indicates abnormal Na⁺-retention, and — when not overcome by drugs such as angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers — may be the only clue to a curable adrenal adenoma.AVS is required to demonstrate lateralisation of aldosterone secretion, justifying adrenalectomy.

Key Words: adrenal microadenoma • adrenal vein sampling • hyperaldosteronism • renin angiotensin

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Journal of Renin-Angiotensin-Aldosterone System, Vol. 9, No. 2, 103-106 (2008)
DOI: 10.3317/jraas.2008.015


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Myint, K. S. Articles by Brown, M. J Search for Related Content PubMed PubMed Citation Articles by Myint, K. S. Articles by Brown, M. J Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Adrenal Gland Cancer High Blood Pressure Hazardous Substances DB HYDROCORTISONE Social Bookmarking                         What's this?