Primary Aldosteronism

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Abstract
Emphasis on the detection and evaluation of hypertension and the increased availability of sensitive and specific radioimmunoassay techniques for measuring plasma renin activity and plasma aldosterone have enhanced the detection of primary aldosteronism. The response of blood pressure after operation in unilateral and bilateral adrenal disease is different. Localizing techniques were compared: adrenal venography, adrenal isotopic scanning, a modified adrenal venous sampling for steroid measurements and the anomalous postural decrease in plasma aldosterone concentration in 51 patients with primary aldosteronism, all of whom had undergone operative confirmation. Adrenalectomy resulted in normal blood pressure in 59%, improvement in 25% and no change in 16%. Correct localization of the lesion was obtained in 47% by the adrenal isotopic scan, in 66% by adrenal venography, and in 91% by the modified adrenal venous hormone technique despite 4 false-positives. Of the 26 patients with an anomalous postural decrease in plasma aldosterone, 88% had a unilateral lesion.
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