Aldosteronoma

ALDOSTERONOMA

What is aldosteronoma?

The adrenal gland normally secretes a hormone called aldosterone. This hormone helps the body to conserve fluids in times of dehydration. When an aldosterone producing adrenal tumor (adenoma) or adrenal tumors, occur, it (they) over produces this substance and results in high blood pressure. This disease called Primary Aldosteronism (or Conn's Syndrome). The tumor that overproduce aldosterone called aldosteronoma.
Bilateral enlargement of both adrenal gland is more common and occurs in 95% of all patients. It presents with the same symptoms and it is called hyperplasia.

Symptoms include:

  • uncontrollable hypertension
  • headaches
  • malaise, muscle weakness, paresthesias, cramps, polyuria, and polydipsia.
  • sometimes low potassium level in the blood
  • Prolong untreated disease may result in significant heart problems from long standing elevated blood pressure (left ventricular hypertrophy), which leads to myocardial infarction (heart attack) and stroke.
  • Metabolic dysfunction (problems with metabolism), that can results in insulin resistance (diabetes) and gaining weight

How is primary aldosteronism diagnosed?

Patient usually has uncontrollable hypertension and low potassium level in the blood. Blood and urine tests for aldosterone and renin is confirm the chemical diagnosis. These tumors are usually small. Aldosteronoma is localized with a CT scan or MRI of the abdomen prior to planning surgery. Also selective sampling of the adrenal veins for aldosterone level helps with localization, since this tumor sometimes is very small (selective venous sampling). Selective venous sampling is invasive procedure that is performed by interventional radiologist. It requires very skilled radiologist who is very experienced with this technique to perform this procedure right, with good result and without complications.

Table 1. Algorithm for diagnosis of Primary Aldosteronism

Algorithm showing use of plasma renin activity (PRA) and plasma aldosterone concentration (PAC) and their ratio (PAC/PRA) for diagnosing aldosteronism in patients with resistant hypertension, hypokalemia, or both. (AACE/AAES Guidelines, ENDOCRINE PRACTICE Vol 15 (Suppl 1) July/August 2009)

Table 2. Algorithm for confirmation of primary aldosteronism

APA = aldosterone-producing adenoma; AVS = adrenal venous sampling; CT = computed tomographic; PAH = primary adrenal hyperplasia. (AACE/AAES Guidelines, ENDOCRINE PRACTICE Vol 15 (Suppl 1) July/August 2009)

How to treat aldosteronism?
Treatment of Primary Aldosteronism that results from adenoma (Conn's Syndrome) is surgical, by removal of entire adrenal gland itself or just the tumor.
Endocrine Society Guideline has recommend the treatment of primary aldosteronism (PA) by unilateral laparoscopic adrenalectomy. It has to be offered to patients with documented unilateral PA (i.e., aldosterone-producing adenoma [APA] or unilateral adrenal hyperplasia [UAH]). If a patient is unable or unwilling to undergo surgery, guideline recommend medical treatment with a mineralocorticoid receptor antagonist. Bilateral enlargement of both adrenal gland treated by medicine (mineralocorticoid receptor antagonist).

Figure 1. Left aldosteronoma (small 1 cm tumor in the left adrenal gland that was the reason for significant hypertension)

Figure 2. Scar with skin glue immediately after posterior retroperitoneal laparoscopic adrenalectomy