ALDOSTERONE-SECRETING ADENOMA IN A CHILD DIAGNOSED BY AN NP-59 IODONORCHOLESTEROL SCAN, ADRENAL VENOUS SAMPLING, AND SPIRAL COMPUTED-TOMOGRAPHY

A 10.5 year old boy was evaluated for a history of severe hypertension that was unresponsive to combined antihypertensive medication. A labo ratory work up revealed hypokalemia, suppressed plasma renin activity, and a high serum aldosterone level. A conventional abdominal computed tomographic scan was normal. An NP-59 iodonorcholesterol (I-131-6-bet a-iodomethyl-nor-cholesterol) scan was performed under dexamethasone s uppression for the differential diagnosis of primary hyperaldosteronis m, The scan revealed an asymmetrical uptake of the radiotracer, with g reater activity on the right side. Adrenal venous sampling demonstrate d significantly increased aldosterone secretion from the right adrenal gland, with suppression on the left side. A preoperative spiral compu ted tomographic scan clearly showed a right adrenal tumor that measure d 1 cm in diameter. The right adrenal gland was surgically removed, al ong with a 1.2 cm aldosteronoma; the hypertension of the patient resol ved immediately after the operation. An aldosterone-producing adenoma is a rare but curable cause of primary hyperaldosteronism in children. Recently available spiral computed tomography seems to be a promising , noninvasive, diagnostic aid in such patients.