Clinical significance of associated nodular lesions of the adrenal in patients with aldosteronoma

Abstract

Thirty-seven patients with primary aldosteronism were treated by unilateral total adrenalectomy during a 7-year period (1981-1987). The 37 patients were classified into 3 groups on the basis of adrenal pathology: unilateral solitary adenoma, 23 cases (group 1); unilateral adenomas, 3 cases (group 2); and adenoma with multiple macro- or microscopic nodules, 11 cases (group 3). The preoperative conditions of the patients (age, duration of hypertension, plasma renin activity, plasma aldosterone concentration, and serum potassium concentration), postoperative sequential changes of hormone levels, and outcome of hypertension were compared among the groups in order to determine whether the differences of adrenal pathology would affect the postoperative course. The preoperative parameters excluding age at surgery did not differ significantly among the 3 groups. The mean age in group 3, however, was slightly higher than in groups 1 and 2 (47.8 versus 42.8 versus 42.7 years). Postoperative hormonal changes were also similar, particularly in groups 1 and 3, staying within the normal range throughout the follow-up period (mean, 31 months; range, 3-86 months). However, postoperative improvement of hypertension showed marked differences, being significantly retarded in patients with multinodular lesions (group 3), about half of whom remained hypertensive even after 1 year. Nodular lesions other than adenoma(s) were, therefore, thought not to contribute to hormonal excess but to result from intractable hypertension.

Aldosteronoma causing Conn’s syndrome: a case report and literature review

“…Furthermore, recurrence of APA in the same adrenal gland [11] 9 years apart has also been mentioned. The incidence of multiple APA varied from 3.9 % to 10 % according to different reports [7,8,12], suggesting the real incidence may be higher than we expected.…”

“…Bilateral solitary aldosteronomas occurring separately and causing primary hyperaldosteronism are rarely reported. From literature, simultaneous presence of unilateral multiple APA [7,8], a hyperfunctioning aldosteronoma with a minimally functioning adenoma on the other side [9], or simultaneous bilateral functioning aldosteronomas [10] have been described. Furthermore, recurrence of APA in the same adrenal gland [11] 9 years apart has also been mentioned.…”

“…Early normalization of blood pressure [7] and potassium level [26] has been reported in the postoperative course of APA. Normalization may take up to one month but is usually achieved within one week after surgery.…”

A Case of Primary Aldosteronism Caused by Multiple Adrenocortical Macronodules

“…PA due to solitary macroadenoma and multiple micronodules are reportedly 35-60% (7, 20) and 9.4-51%, respectively (20)(21)(22). On the other hand, PA due to multiple macronodules is extremely rare and as far as we have searched, only 3 cases have been reported (9)(10)(11). In these cases, the diameter of nodules rangedfrom 5-22 mm, biochemical parameters were consistent with primary hyperaldosteronism and multiple unilateral adrenal adenomas, and immunohistochemical analysis confirmed that aldosterone was produced in each of the nodules (10).…”

“…PA caused by an aldosterone producing tumor (APA) and bilateral idiopathic hyperaldosteronism (IHA) are the most common subtypes of PA. A much less common form, unilateral hyperplasia or primary adrenal hyperplasia (PAH), is caused by a nodular region in the zona glomerulosa of predominantly one adrenal gland. Although unilateral multiple adrenocortical micronodules (UMN) have been reported (8), PA due to multiple macronodules is extremely rare (9)(10)(11).…”