[Aldosterone precursors and hypertension with hypokalemia and adrenal module non caused by primary hyperaldosteronism].
The purpose of the study was to evaluate the interest of aldosterone precursors assays in arterial hypertension with hypokaliemia and adrenal nodules non due to aldosterone. Seven hypertensive patients, 3 men and 4 women, aged 59.5 +/- 10.1 years were included in the study. After drug withdrawal, kaliemia was 3.1 +/- 0.3 mmol/l (2.7-3.6), active renin 2.9 +/- 1.4 ng/l, plasma aldosterone (aldo) 108 +/- 49.4 pg/ml, cortisol 13 +/- 3.1 micrograms/100 ml, and [S] 0.47 +/- 0.5 micrograms/100 ml. Adrenal CT scan showed an adenoma in 3 patients (30.5 +/- 5 mm) and an unilateral nodular hyperplasia in 4 patients. In all patients, the plasma levels (RIA, chomatographic step) of the following steroids in the mineralocorticoid (MC) pathway were determined: DOC, 18 OH-DOC, B, 18 OH-B and aldosterone. Two from 7 (28%) exerted aldosterone precursors excess, 1 with DOC-producing adenoma (DOC-PA) (table), and 1 with a partial 11 beta hydroxylase deficiency (DOC: 211 pg/ml; S: 1 mu/100 ml). Aldosterone/DOC + 18 OH-DOC ratio proposed as a malignancy index was decreased in the patient with DOC-PA (8.1). No dysfunction in the MC pathway was identified in the 5 other patients. [table: see text] The study suggests the relevance of aldosterone precursors assays in low renin hypertension non due to aldosterone and in incidentally discovered adrenal masses.
Chamontin
B
B
Service de médecine interne et hypertension artérielle, CHU Purpan, Toulouse.
Blanchouin-Emeric
N
N
Amar
J
J
Khatibi
F
F
Vernier
I
I
Bennet
A
A
Aupetit-Faisant
B
B
Salvador
M
M
D000236:Adenoma / Q000097:blood / Q000150:complications*; D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000150:complications*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood; D006973:Hypertension / Q000097:blood / Q000209:etiology*; D007008:Hypokalemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000097:blood*; D012083:Renin / Q000097:blood; D014057:Tomography, X-Ray Computed
D008901:Mineralocorticoids; D000450:Aldosterone; D012083:Renin
Précurseurs de l'aldostérone et hypertension artérielle avec hypokaliémie et nodule surrénalien, non attribuée à un hyperaldostéronisme primaire.