[Endosonography -- an additional diagnostic possibility in the differentiation between the two common types of primary hyperaldosteronism].
BACKGROUND
Primary aldosteronism is an important and one of the few potentially curable forms of secondary hypertension. The distinction between aldosterone-producing adenoma (APA) and idiopathic adrenal hyperplasia (IHA) may be difficult, but establishing the correct diagnosis is essential because surgery is only effective in patients with adrenal adenoma.


METHODS
The case of a 65-year-old man with long-term hypertension due to an APA is reported. The routine laboratory tests displayed an elevated plasma aldosterone/renin quotient as well as an elevated 24-h urinary excretion of aldosterone and its metabolites. The serum aldosterone concentration did not decrease normally in the saline suppression test. The posture testing demonstrated an increase in aldosterone. These facts might lead to the conclusion of an IHA. Magnetic resonance imaging (MRI) of the adrenal glands revealed no abnormalities. Because of the unusual combination of laboratory findings and radiologic results an endosonographic examination of the adrenal glands was performed which yielded a unilateral adrenal adenoma. With establishing this diagnosis, curative surgery became possible.


CONCLUSIONS
This case demonstrates that in the differential diagnosis of primary aldosteronism, endosonography is more important than previously discussed. It may be helpful in the differentiation of an unusual constellation of laboratory and radiologic findings.
Roggenland
Daniela
D
Medizinische Klinik I, Universitätsklinikum Bergmannsheil, Ruhr-Universität, Bochum.
Schneider
Stephan
S
Klein
Harald H
HH
Kann
Peter H
PH
D000236:Adenoma / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000601:surgery; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis; D000315:Adrenalectomy; D000368:Aged; D000450:Aldosterone / Q000097:blood / Q000378:metabolism; D003937:Diagnosis, Differential; D019160:Endosonography; D005500:Follow-Up Studies; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D011187:Posture; D013997:Time Factors; D016896:Treatment Outcome
D000450:Aldosterone