Adrenalectomy for Primary Aldosteronism

David G. Martinez

doi:10.7326/0003-4819-138-2-200301210-00023

Letters |21 January 2003

Adrenalectomy for Primary Aldosteronism

David G. Martinez, MD

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TO THE EDITOR:

Sawka and colleagues found only a 33% cure rate with adrenalectomy in patients with primary aldosteronism (1). One explanation for this finding could be that some of these patients did not have a functioning adenoma or had concomitant adrenal hyperplasia. Ninety-two percent of Sawka and colleagues' patients reportedly had an adenoma at surgery; however, laboratory data confirming a functioning adenoma were not presented.

I cared for a 72-year-old hypertensive man with confirmed renal potassium wasting and primary aldosteronism. A computed tomography (CT) scan showed a left adrenal mass. Laboratory data suggested adrenal hyperplasia (2). Twenty-fourhour urine sodium level was 434 mmol/d, and 24-hour urine aldosterone level was 47.2 nmol/d. Serum levels of 18-hydroxycorticosterone, cortisol, and aldosterone were 0.99 nmol/L, 419.37 nmol/L, and 0.71 nmol/L, respectively, after overnight recumbency. After 4 hours of ambulation, serum cortisol and aldosterone levels were 380.74 nmol/L and 0.96 nmol/L, respectively. On the basis of these laboratory data, we performed adrenal venous sampling under intravenous adrenocorticotropin stimulation (3). The results suggested bilateral adrenal hyperplasia (Table). The patient was treated successfully with spironolactone alone; therapy with all other potassium supplements and antihypertensive drugs was discontinued.

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2003 American College of Physicians

Letters |21 January 2003

Adrenalectomy for Primary Aldosteronism

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Letters |21 January 2003

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