DIAGNOSIS OF PRIMARY HYPERALDOSTERONISM / 中华内分泌代谢杂志

ABSTRACT

The diagnosis of primary hyperal dosteronism was discussed on the basis of clinical data of 164 cases Among these, 74 cases were male, 90 cases were female, aged from 24 to 58 years. Aldostcronoma was found in 149 patients, adrenal carcinoma in 1, and adrenal hyperplasia in 14. Hypertension was present in all but 1 cases. Hypokaliemia was persistent in 72%, of the patients, and intermitent in 28%.An elevated aldosterone level in urine, scrum or saliva combined with suppressed plasma PRA and AT Ⅱ concentration, and the failure of the plasma PRA and AT Ⅱ to increase after a provocating stimulation were of great value in the diagnosis of primary hyperaldostcronism. If the blood pressure was decreased and the electrolytes disturbance were corrected after oral administration of spironolactone (240-400 mg/day) for more than two weeks, it was not only of diagnostic value for primary hyperaldosteronism, but also could be used as preoperative preparing measure for the surgery of aldosteronoma. There was a fall of plasma aldosterone after 4 hour upright posture in the morning in 12 out of 21 cases of aldosteronoma. Retro-peritoneal insufflation (81 cases) was of diagnostic value in only 24.7% of patients. Radioio-do-cholesterol scintigraphy of the adrenal glands correctly localise the adenoma in 91.2%, of 102 cases, the diagnostic accuracy of this method for adrenal hyperplasia was 64%. Adrenal ultrasonography successfully located the aldosteronoma in 75% of 32 cases.