Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Clin Exp Hypertens. 2012;34(1):53-6. doi: 10.3109/10641963.2011.618204. Epub 2011 Oct 18.
Primary aldosteronism (PA) is a syndrome which includes a group of clinical entities in which aldosterone production is inappropriately high and nonsupressible by sodium loading. The most frequent causes of PA are adrenal adenoma and unilateral or bilateral primary hyperplasia.
We report a case of a 55-year-old man with a 10-year history of hypertension in whom functional hormonal studies were indicative of PA. Because adrenal venus sampling was not available at our hospital, the investigation was conducted with a computed tomography (CT) scan and a scan with 131-iodocholesterol (NP-59) which both revealed a left adrenal adenoma.
The tumor was excised laparoscopically without any complications and the histological findings confirmed the diagnosis of an aldosterone-producing adenoma. Blood pressure remained normal despite the discontinuation of antihypertensive drugs, further supporting that the adrenal tumor was indeed the cause of high blood pressure. Unfortunately, blood pressure began to rise again 2 months later, and laboratory findings indicated the presence of PA once again. Spironolactone was instituted and blood pressure significantly improved and was finally controlled by the addition of amlodipine.
We report this case to underline the difficulties in the discrimination between adenoma and hyperplasia in everyday clinical practice. Although the CT and scintigraphic findings strongly pointed toward an adenoma, the fact that PA re-appeared shortly after the operation, indicated that the underlying cause of the PA was hyperplasia and not adenoma after all.
原醛症（PA）是一种综合征，包括一组临床实体，其中醛固酮的产生不适当地升高且不能被钠负荷抑制。PA 最常见的原因是肾上腺腺瘤和单侧或双侧原发性增生。
我们报告了 1 例 55 岁男性，有 10 年高血压病史，功能激素研究表明存在 PA。由于我们医院没有进行肾上腺静脉取样，因此进行了计算机断层扫描（CT）和 131-碘胆固醇（NP-59）扫描的检查，两者均显示左侧肾上腺腺瘤。
肿瘤经腹腔镜切除，无任何并发症，组织学检查结果证实为醛固酮分泌腺瘤。尽管停止了降压药物治疗，但血压仍保持正常，进一步支持肾上腺肿瘤确实是高血压的原因。不幸的是，2 个月后血压再次升高，实验室检查结果再次表明存在 PA。开始使用螺内酯，血压显著改善，最后通过添加氨氯地平得到控制。
我们报告这个病例是为了强调在日常临床实践中区分腺瘤和增生的困难。尽管 CT 和闪烁扫描结果强烈指向腺瘤，但 PA 在手术后不久再次出现的事实表明，PA 的根本原因是增生而不是腺瘤。
