Clinical Characteristics

The diagnosis of primary hyperaldosteronism is usually made between the ages of 30 and 60 years. The disease is more common in women than in men. The ages of the patients in our series ranged from 17 to 74, with a mean of 47.0 years. The female-to-male ratio was 1.5:1 (131:85) in our series, which corresponds to that in most other studies.17"23

The hypertension of primary aldosteronism is moderate to severe and is indistinguishable from that seen in other disorders. The highest blood pressure recorded in our series was 300/150 mm Hg, and malignant hypertension is rare in this disorder. The duration of hypertension before recognition of hyperaldosteronism is variable. Among our patients, the duration of documented hypertension ranged from 1 to 480 months (median, 104 months), corresponding to that in other reports.17,22,23 The other characteristic symptoms— muscle weakness, cramping, intermittent paralysis, headaches, polydipsia, polyuria, and nocturia—are mainly attributable to hypokalemia. Because many patients were initially treated medically for hypertension by the referring physician without a diagnosis, the precise incidence of symptoms specific for hyperaldosteronism is not always clear. Periodic paralysis has been considered to be a common presenting symptom in Asian patients.21,24 In our series, the incidence was approximately 23%.

Hyperparathyroidism or prolactinoma coexistent with primary aldosteronism has been reported. Gordon and Stowasser25 reported that 14 of 596 patients with primary hyperaldosteronism had hyperparathyroidism, and 4 had pituitary adenoma. In our series, two patients had primary hyperparathyroidism and another had prolactinoma. Some of these patients may have rare multiple endocrine neoplasia (MEN) type l.26 28 Whether this combination of endocrine disorders represents a variant of MEN or two sporadic conditions is unknown. Family history and testing for germline MEN 1 gene mutation on chromosome 11 as well as documenting hypercalcemia and hyperparathyroidism should clarify this situation.

FIGURE 68-2. Cut surfaces of adrenal glands removed from patients with primary hyperaldosteronism, showing an adenoma associated with macronodular lesions (arrows) (A) and double adenomas (B). (From Ito Y, Fujimoto Y, Obara T, et al. Clinical significance of associated nodular lesions of the adrenal in patients with aldosteronoma. World J Surg 1990; 14:331.)

FIGURE 68-2. Cut surfaces of adrenal glands removed from patients with primary hyperaldosteronism, showing an adenoma associated with macronodular lesions (arrows) (A) and double adenomas (B). (From Ito Y, Fujimoto Y, Obara T, et al. Clinical significance of associated nodular lesions of the adrenal in patients with aldosteronoma. World J Surg 1990; 14:331.)

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