Anomalous Postural Aldosterone Response in Glucocorticoid-Suppressible Hyperaldosteronism

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Abstract
IN normal persons the plasma aldosterone concentration rises with assumption of upright posture in response to activation of the renin-angiotensin system and to decreased metabolic clearance of aldosterone resulting from reduced hepatic blood flow.1 In contrast, patients with primary aldosteronism due to an adrenal adenoma have a paradoxical fall in plasma aldosterone after four hours of upright posture.2 3 4 5 This response is thought to be due to the ACTH-mediated modulation of aldosterone secretion combined with the normal diurnal rhythm of ACTH secretion, and it has been useful in differentiating unilateral from bilateral forms of the disease.2 3 4 5 6 We report a similar, anomalous . . .