title: Clinical characteristics of aldosterone-producing microadenoma, macroadenoma, and idiopathic hyperaldosteronism in 93 patients with primary aldosteronism.
abstract: Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is a form of surgically curable secondary hypertension, and distinguishing APA from idiopathic hyperaldosteronism (IHA) is important for treatment. We made a differential diagnosis between APA and IHA using imaging tests such as adrenal CT and MRI as well as adrenal venous sampling (AVS) in all 93 cases of PA presenting at our institutions over the last decade. We identified 27 patients with aldosterone-producing microadenoma (APmicroA), all of whom could be diagnosed by AVS but not by the imaging tests. Then, we compared the clinical and roent-genological findings of these 27 patients with those of 42 patients with aldosterone-producing macroadenoma (APmacroA) and of 24 patients with IHA. Using surgically removed adrenal tissues, histopathological examinations and immunohistochemical analyses of steroidogenic enzymes were conducted. The findings for APmicroA were similar to those for APmacroA, except with respect to the diameter of the adrenal adenomas. Endocrinological and roentgenological findings for APmicroA were similar to those for IHA, but not to those for APmacroA. The rate of cure of hypertension was much greater in patients with APmicroA than in patients with APmacroA after the unilateral adrenalectomy (odds ratio, 4.0; p=0.028). In conclusion, it is important to accurately diagnose APmicroA, in which the laterality of the hyperproduction of aldosterone is only detectable by AVS, and to treat these patients by unilateral adrenalectomy in order to avoid long-term medical treatment and prevent hypertensive vascular complications.
authors.affiliation: Department of Internal Medicine, Social Insurance Central General Hospital, Tokyo, Japan. omura@shahochu.jp
authors.forename: Masao
authors.initials: M
authors.lastname: Omura
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sasano
authors.forename: Jun
authors.initials: J
authors.lastname: Saito
authors.forename: Kunio
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kakuta
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishikawa
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D000310:Adrenal Gland Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D000311:Adrenal Glands / Q000473:pathology*; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies