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Management of Aldosteronoma

  • Hadley E. Ritter
  • Benjamin C. JamesEmail author
Chapter

Abstract

Primary hyperaldosteronism is a condition of excess production of aldosterone from the adrenal gland. The condition may be caused by a single adenoma or idiopathic hyperplasia of the adrenal glands. Clinically, primary hyperaldosteronism often results in difficult-to-control hypertension. Biochemical evaluation should include a plasma aldosterone-to-renin ratio, which when greater than 35 is highly suggestive of primary hyperaldosteronism. Imaging should include a non-contrast computed tomography (CT) scan. Adrenal nodules associated with primary hyperaldosteronism are typically 1–3 cm in size. Confirmatory lateralization with adrenal vein sampling should be considered when imaging is not clear. Biopsy of the adrenal gland should never be performed. For patients with unilateral disease, the treatment of choice is a laparoscopic adrenalectomy. In the setting of bilateral disease, patients should be medically managed with spironolactone or eplerenone.

Keywords

Conn’s Syndrome Spironolactone Eplerenone Laparoscopic adrenalectomy 

References

  1. 1.
    Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Chapter 16: Endocrine hypertension. In: Williams textbook of endocrinology. 13th ed. Philadelphia: Elsevier; 2016. p. 566–88.Google Scholar
  2. 2.
    Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF Jr, Montori V. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266–81.CrossRefGoogle Scholar
  3. 3.
    Arlt W. A detour guide to the Endocrine Society clinical practice guideline on case detection, diagnosis and treatment of patients with primary aldosteronism. Eur J Endocrinol. 2010;162:435–8.CrossRefGoogle Scholar
  4. 4.
    Montori VM, WF Y. Use of plasma aldosterone concentration-to-plasma renin activity ratio as a screening test for primary aldosteronism. A systematic review of the literature. Endocrinol Metab Clin N Am. 2002;31:619–32.CrossRefGoogle Scholar

Suggested Reading

  1. Clark OH, Duh Q-Y, Gosnell JE, Shen W. Textbook of endocrine surgery. 3rd ed. New Delhi: Jaypee Brothers Medical Publishers; 2014.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryIndiana UniversityIndianapolisUSA
  2. 2.Department of SurgeryHarvard Medical SchoolBostonUSA
  3. 3.Department of SurgeryBeth Israel Deaconess Medical CenterBostonUSA

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