DISTINGUISHING ALDOSTERONE‐PRODUCING ADENOMA FROM OTHER FORMS OF HYPERALDOSTERONISM AND LATERALIZING THE TUMOUR PRE‐OPERATIVELY

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Abstract
SUMMARY: 1. In 14 hypertensive patients aldosterone/cortisol ratio was always lower in a peripheral vein or low IVC than in either adrenal vein. In four patients with a right‐sided aldosterone‐producing adenoma (APA), the aldosterone/cortisol ratio in peripheral vein was always higher than in the left adrenal vein. If only the left adrenal vein is cannulated, right‐sided APA can still be diagnosed with certainty.2. In three patients with glucocorticoid‐suppressible hyperaldosteronism, urinary excretion of both 18‐oxocortisol and 18‐hydroxycortisol was elevated. In four patients with APA excretion of 18‐oxocortisol was elevated. In two of three patients with bilateral adrenal hyperplasia (BH), excretion of both steroids was normal.3. 75Se‐selenomethylcholesterol scanning correctly lateralized five APA, but falsely lateralized a patient with BH. Results with CT scans were often misleading.

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