ALDOSTERONE PRECURSORS AND ARTERIAL-HYPER TENSION WITH ADRENAL NODULES NON DUE TO ALDOSTERONISM

The purpose of the study was to evaluate the interest of aldosterone p recursors assays in arterial hypertension with hypokaliemia and adrena l nodules non due to aldosterone. Seven hypertensive patients, 3 men a nd 4 women, aged 59.3+/-10.1 years were included in the study, After d rug 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 1 3+/-3.1 mu g/100 ml, and [S] 0.47+/-0.5 mu g/100 ml. Adrenal CT scan s howed an adenoma in 3 patients (30.5+/-5 mm) and an unilateral nodular hyperplasia in 4 patients. In all patients, the plasma levels (RIA, c homatographic step) of the following steroids in the mineralocorticoid (MC) pathway were determined: DOC, 18 OH-DOC, B, 18 OH-B and aldoster one. Two from 7 (28%) exerted aldosterone precursors excess, 1 with DO C-producing adenoma (DOC-PA) (table), and 1 with a partial 11 beta hyd roxylase 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 p atient with DOC-PA (8.1). No dysfunction in the MC pathway was identif ied in the 5 other patients.