Medical Management of Aldosterone-Producing Adenomas

Nor N. Chan

doi:10.7326/0003-4819-132-7-200004040-00022

Letters |4 April 2000

Medical Management of Aldosterone-Producing Adenomas

Nor N. Chan, MB, ChB, MRCP

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TO THE EDITOR:

Ghose and colleagues (1) showed that long-term medical management (5 to 17 years) is a reasonable option for aldosterone-producing adenomas diagnosed by standard biochemistry and computed tomography in terms of blood pressure control and normalization of serum potassium levels in patients who decline or are unfit for surgery. However, I have concerns about the diagnostic accuracy in their cohort of patients. The use of computed tomography alone without adrenal venous sampling is often inadequate in differentiating between aldosterone-producing adenomas and adrenocortical hyperplasia (2, 3), the two major causes of primary hyperaldosteronism. In a series of hypertensive patients with primary hyperaldosteronism, computed tomography alone had a low specificity (58%) and a positive predictive value of only 72% (4). With the additional use of adrenal venous sampling, a significant proportion of patients was found to have nonfunctional adrenal masses with coexisting adrenal hyperplasia (4).

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2000 American College of Physicians

Letters |4 April 2000

Medical Management of Aldosterone-Producing Adenomas

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Letters |4 April 2000

Medical Management of Aldosterone-Producing Adenomas

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