Henry Ford Hospital Medical Journal


This report describes the experience with the diagnosis and treatment of primary aldosteronism at Henry Ford Hospital since 1980. Of the 28 patients who received the diagnosis. 13 had unilateral primary aldosteronism and 15 had idiopathic hyperaldosteronism. Individual cases are used to demonstrate clinical points. The clue to the presence of primary aldosteronism in a hypertensive patient is hypokalemia. The diagnosis is established by showing 1) high plasma aldosterone after intravenous saline or high urinary aldosterone after treatment with sodium chloride orally, and 2) low stimulated plasma renin activity. Treatment with potassium supplement should be given during the testing. Unilateral primary aldosteronism can be identified and localized by adrenal cortical scintigraphy using 131-iodine iodomethyl 19-norcholesterol (NP-59) during dexamethasone treatment to decrease Cortisol synthesis. Unilateral adrenalectomy will cure the hypokalemia and relieve (60%) or improve (90%) the hypertension in unilateral primary aldosteronism. Idiopathic hyperaldosteronism is treated medically, with spironolactone or amiloride and calcium-channel blocking drugs.