Adrenal venous sampling is absolutely requisite for definitively diagnosing primary aldosteronism as well as for detecting laterality of the adrenal lesion

Primary aldosteronism: comparison between guidelines of the Japanese and the US Endocrine Society

The US and Japanese Endocrine Societies recently both developed a therapeutic guideline for primary aldosteronism (PA). These guidelines indicate that differential diagnosis between PA caused by aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (or idiopathic hyperaldosteronism [IHA]) is important and critical for treatment choice, while they show some inconsistency due to different frequencies of disorders and medical circumstances in respective countries. Japanese Endocrine Society guidelines have a unique description on the adrenal vein sampling (AVS) against microAPA, detection of which is difficult with current imaging tools and thus is frequently misdiagnosed as IHA. We reported that AVS performed in combination with adrenocorticotropic hormone stimulation was useful for diagnosing laterality of PA lesions, and APA underlay 74% of our cases with significant reduction of IHA compared with those previously reported. Laterality of PA should be precisely evaluated with AVS and imaging studies, as the results strongly influence the choice of therapeutic strategies.

Primary aldosteronism associated with severe rhabdomyolysis due to profound hypokalemia

A 55-year-old Japanese man was admitted to our hospital with severe weakness. Without measurement of serum electrolyte concentrations, diuretic therapy for hypertension was started 2 weeks prior to admission. Laboratory findings showed profound hypokalemia (1.4 mEq/L), and extreme elevation of the serum creatinine phosphokinase levels (15,760 IU/L), suggesting that the patient had hypokalemic paralysis and hypokalemia-induced rhabdomyolysis. Further evaluations, including adrenal venous sampling strongly suggested that he had primary aldosteronism. He was treated successfully by laparoscopic adrenalectomy. This case provides an important lesson that serum electrolyte concentrations should be measured in hypertensive patients before the administration of antihypertensive agents.