Primary Aldosteronism with Unusual Secretory Pattern1

ABSTRACT An adrenocortical tumor that secreted normal amounts of aldosterone was successfully removed and the classic findings of hypokalemic alkalosis and hypertension in primary aldosteronism were corrected. The tumor failed to alter aldosterone excretion during potassium repletion, desoxycorticosterone administration, sodium restriction and pituitary suppression. Normal aldosterone secretion probably resulted from the degree of potassium depletion but was sufficient under this condition to produce the manifestations of excessive aldosterone production. Failure to reduce aldosterone secretion during administration of desoxycorticosterone acetate in the presence of strong clinical evidence for primary aldosteronism should warrant surgical exploration for a tumor.