Pathological and clinical studies on primary aldosteronism

: In the surgical treatment of patients with primary aldosteronism, differentiation of idiopathic hyperaldosteronism due to bilateral adrenal hyperplasia should be kept in mind. Controversies exist, on the other hand, concerning the diagnosis and management of multiple nodular hyperplasia which often coxists with adrenal adenoma. We studied correlations between pathological findings and clinical diagnosis on 13 patients with primary aldosteronism who were operated on during the 19 year period from 1963 to 1981, and the results were as follows; (1) Histologically, adrenal glands of these patients were classified into three subgroups, namely i) adrenocortical adenoma alone, ii) adrenocortical adenoma associated with multiple nodular hyperplasia, and iii) nodules of multiple nodular hyperplasia alone. (2) Clinically, the latter two subgroups showed increase in plasma renin activity following the combination test of volume depletion and spironolactone administration. From these results it is suggested that even in patients with primary aldosteronism multiple nodular hyperplasia of the adrenal cortex can coexist together with adrenal adenoma, and that coexistence of this hyperplasia may modify some clinical features of the disease.