Diagnosis and Localization in Primary Aldosteronism

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Abstract
Aldosterone in peripheral and adrenal vein plasma was measured in 21 patients highly suspect for primary aldosteronism. Peripheral and adrenal vein aldosterone levels were measured by a sensitive, accurate radioimmunoassay. Base-line and postfludrocortisone plasma aldosterone values were elevated in all patients while they were supine, with values ranging above normal to very high levels. Adrenal venograms were done in sixteen patients, and a positive radiologic interpretation was made in three fourths. The adrenalvein aldosterone values, however, were diagnostic in all patients. Primary aldosteronism, due to an adenoma, was shown by high levels of aldosterone on the side of the lesion and much lower levels, usually approaching peripheral, on the unaffected side. Aldosteronism due to bilateral hyperplasia appears to be associated with symmetrically elevated levels. These studies suggest that adrenal vein analysis of aldosterone is the most important part of the venogram procedure for localization and diagnosis in primary aldosteronism.
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