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Journal of Clinical Endocrinology & Metabolism, Vol 75, 323-327, Copyright © 1992 by Endocrine Society

ARTICLES

Plasma aldosterone response to upright posture and angiotensin II infusion in aldosterone-producing adenoma

K Nomura, S Toraya, N Horiba, M Ujihara, M Aiba and H Demura
Department of Medicine, Tokyo Women's Medical College, Japan.

Nineteen patients with primary aldosteronism due to surgically confirmed aldosterone-producing adenoma (APA) were examined to evaluate the response of aldosterone to upright posture and angiotensin II infusion. Upright posture reportedly decreases the plasma aldosterone concentration (PAC) in APA but raises it in idiopathic hyperaldosteronism. However, our findings showed the opposite result, in that the upright posture did not change or raised PAC in 15 of 19 cases (79%). Angiotensin II was infused i.v. at doses from 0.5-2 ng/min.kg body weight in six patients in whom the upright posture raised PAC, but did not raise PAC in all cases. This result supports the assumption that APA is functionally insensitive to angiotensin II. A concomitant rise of ACTH, pretreatment with calcium channel blockade, and other modulating factors may be involved in this PAC rise. Whatever the reason, such a high frequency of patients with increased PAC in APA raises some question about the clinical value of the upright posture test. We believe, then, there is reason to check any interpretation concerning increased PAC in the case of the upright posture test in distinguishing between APA and idiopathic hyperaldosteronism.


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V.C. Wu, S.C. Chueh, H.W. Chang, W.C. Lin, K.L. Liu, H.Y. Li, Y.H. Lin, K.D. Wu, and B.S. Hsieh
Bilateral aldosterone-producing adenomas: differentiation from bilateral adrenal hyperplasia
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D. Hirohara, K. Nomura, T. Okamoto, M. Ujihara, and K. Takano
Performance of the Basal Aldosterone to Renin Ratio and of the Renin Stimulation Test by Furosemide and Upright Posture in Screening for Aldosterone-Producing Adenoma in Low Renin Hypertensives
J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4292 - 4298.
[Abstract] [Full Text] [PDF]


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