UNILATERAL AUTONOMOUS ALDOSTERONE PRODUCT ION IN GLUCOCORTICOID-REMEDIABLE HYPERALDOSTERONISM

A 21-year-old woman with weight loss, palpitations and facial hush was found to have hypertension (up to 200/130 mm Hg) and mild hyperkalaem ia (3,4 mmol/l). Extensive diagnostic tests revealed hyperaldosteronis m with contrast storing in the right adrenal gland on scintigraphy aft er injection of dexamethasone (2 mg daily for one week). The hyperaldo steronism could not be suppressed by dexamethasone. Analysis of venous blood separately from each side pointed to aldosterone production in the right adrenal (right renal vein: 80 ng/dl, drainage area of the ri ght adrenal vein: 114 ng/dl, left renal vein: too low to measure). The right adrenal gland was removed. No adenoma was found histologically. After the operation the aldosterone level was reduced and the blood p ressure transiently fell. But both had risen again after 3 months. Ren ewed tests revealed dexamethasone-remediable hyperaldosteronism. On tr eatment with hydrocortisone (15-5-5 mg) and 50 mg metoprolol the patie nt became normotensive without any other medication.