Aldosteronomas

Primary hyperaldosteronism (Conn's syndrome) is a rare etiology of hypertension (<1%). Other clinical manifestations of Conn's syndrome arise from an increased total body sodium content and a deficit in total body potassium. Symptoms include urinary urgency or frequency, nocturia, muscle weakness, paresthesias, or visual disturbances (4,11). Computed tomography scan or magnetic resonance imaging can detect adrenal adenomas as small as 1 cm in size. Laboratory manifestations include hypokalemia, elevated plasma and urinary aldosterone level, elevated serum aldosterone-to-renin ratio, and suppressed plasma renin activity (4,11). Once an important part of the evaluation, adrenal vein sampling is currently rarely used to confirm and localize the lesion.

Once the diagnosis is confirmed, medical control of hypertension and correction of hypokalemia should be instituted at least several weeks prior to adrenalectomy. The most effective medication for management of hyperaldosteronism is spironolactone, a competitive antagonist of the aldosterone receptor (4). Side effects of spironolactone include hyperkalemia, sexual dysfunction, gynecomastia, gastrointestinal disturbances, and metabolic acidosis (12). Alternative medications include potassium sparing diuretics, calcium channel blockers, or converting enzyme inhibitors (11). Adrenalectomy improves or cures hypertension in approximately 90% of patients (13).

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