PRIMARY HYPERALDOSTERONISM (REPORT OF 2 C ASES)

Primary hyperaldosteronism (PHA) represents less than 1 to 2% of all c auses of hypertension (HT). We report 2 cases of primary hyperaldoster onism which emphasize the difficulty of distinguishing neoplastic PHA from idiopathic PHA, observed in a 60-year-old woman and a 42-year old woman, respectively. In both cases, the diagnosis of PHA was suggeste d by marked hypokalaemia with inappropriate potassium excretion and wa s confirmed by hyperaldosteronaemia and low and poorly stimulated reni n activity. In the first case, computed tomography showed nodular hype rplasia of the 2 adrenal glands. The patient was treated with spironol actone and calcium channel blockers which controlled blood pressure an d serum potassium. In the second case, computed tomography and magneti c resonance imaging revealed an adrenocortical adenoma confirmed by pa thological examination after the operation. The diagnosis of primary h yperaldosteronism is based on three steps: detection, positive diagnos is and aetiological diagnosis. Detection is essentially based on demon stration of hypokalaemia. Positive diagnosis is based on demonstration of elevated aldosterone secretion with inhibited renin secretion. The aetiological diagnosis is dominated by the differentiation between Co nn's adenoma and bilateral adrenal hyperplasia, which has therapeutic implications.