Demographics And Clinical Features

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Primary hyperaldosteronism typically affects patients between 30 and 50 years of age and is twice as common in women as in men.1 In recent studies, the disease affects up to 5% of patients evaluated in hypertension clinics.1,2 These patients usually present with hypertension of variable severity and duration that is indistinguishable from hypertension caused by other diseases and often exhibit symptoms and signs of hypokalemia (muscle weakness, muscle cramps,

Figure 8-1. A 45-year-old woman with a 4-year history of severe hypertension. Workup showed a serum aldosterone level of 86, a renin activity level of 0.4, and a ratio of 215. A thin-cut computed tomographic scan showed a homogeneous 2 cm left adrenal tumor (arrow) and a normal right adrenal gland. A, She underwent a laparoscopic left adrenalectomy. Pathology showed a 2 cm adrenal cortical adenoma with focally prominent zona glomerulosa consistent with an aldosteronoma. B, Her hypertension improved after the operation with no need for medication.

Figure 8-1. A 45-year-old woman with a 4-year history of severe hypertension. Workup showed a serum aldosterone level of 86, a renin activity level of 0.4, and a ratio of 215. A thin-cut computed tomographic scan showed a homogeneous 2 cm left adrenal tumor (arrow) and a normal right adrenal gland. A, She underwent a laparoscopic left adrenalectomy. Pathology showed a 2 cm adrenal cortical adenoma with focally prominent zona glomerulosa consistent with an aldosteronoma. B, Her hypertension improved after the operation with no need for medication.

electrocardiographic changes). In some cases, the patients have been worked up for other causes of hypertension and are usually taking antihypertensive medications. Eating black licorice can mimic primary hyperaldosteronism. Primary hyperaldostero-nism almost always occurs sporadically but, in rare cases, may be associated with other endocrine disorders, including hyperparathyroidism, prolactinoma, and multiple endocrine neoplasia (MEN) type I.

We recently reviewed the medical records of 42 patients with surgically correctable primary hyperal-dosteronism who were treated in the 1990s6; interestingly, our patient demographic profiles were markedly different from those of previous studies. The gender breakdown of our 42 patients included 29 men and 13 women, a complete reversal of typical gender ratios seen in this disease. In addition, the median age of the patients in our series was 50 years (range 23 to 72 years), which is slightly higher than the age of patients reported by other authors. These differences in demographics may have been a result of our small sample size but could also reflect changing patterns in the diagnosis and selection of patients for surgical treatment. High-resolution CT has facilitated the localization of adrenal adenomas (Figure 8-2), which has resulted in the diagnosis of patients with tumors that may have previously been missed; surgeons may thus be operating on a different patient population with this disease than in past decades.3 In addition, the introduction of laparoscopic adrenalec-tomy may have altered the referral patterns of primary care physicians and endocrinologists4,5; these physicians may perceive the laparoscopic procedure to be less invasive and thus less dangerous for patients and may therefore be more willing to refer older patients and patients with less severe disease, patients whom they would previously have treated with medications.

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Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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