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

  title={Plasma aldosterone response to upright posture and angiotensin II infusion in aldosterone-producing adenoma.},
  author={Kaoru Nomura and S Toraya and Nobuo Horiba and Makoto Ujihara and Motohiko Aiba and Hiroshi Demura},
  journal={The Journal of clinical endocrinology and metabolism},
  volume={75 1},
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… 

Characteristics of aldosterone-producing adenoma responsive to upright posture.

Two patients with AP-RA were found in 19 patients with aldosteronoma who were examined by UP stimulation and were treated surgically, and the density of the normal adrenal gland adjacent to the adenoma increased but that of theadenoma did not in APA, making a clear distinction between the adanoma and the gland.

Characteristics of Aldosterone-Producing Responsive to Upright Posture Adenoma

It was showed that AP-RA are difficult to distinguish from IHA not only because of the similar responsiveness of PAC to UP but also because of difficulties in detecting adrenal tumor by adrenal CT scanning.

The Ratio of Plasma Aldosterone Concentration to Potassium in Adrenocorticotropin Stimulation Test is a Possible New Index for Diagnosis of Aldosterone-producing Adenoma in Patients with Primary Aldosteronism

This study indicated that APR after the ACTH stimulation test may be a useful and accurate parameter in cases of PA and that AVS is strongly recommended for localization of aldosterone hypersecretion.

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.

The plasma aldosterone concentration to PRA ratio is an effective screening and diagnostic test when a triple level likelihood ratio is applied and did not raise the posttest probability over that obtained using the ald testosterone/PRA ratio.


In patients with aldosterone‐producing adenoma or primary adrenal hyperplasia, unilateral adrenalectomy generally results in the normalization of ald testosterone secretion and kalemia, but normotension is achieved in only half of the cases.


The results suggest that angiotensin I1 induces ald testosterone release by an activation of tumor uninvolved cortical cells and that the enucleation of aldosterone-producing adenoma is more preferable than unilateral adrenalectomy.

New diagnostic procedure for primary aldosteronism: adrenal venous sampling under adrenocorticotropic hormone and angiotensin II receptor blocker--application to a case of bilateral multiple adrenal microadenomas.

  • K. YamaharaH. Itoh K. Nakao
  • Medicine, Biology
    Hypertension research : official journal of the Japanese Society of Hypertension
  • 2002
A new diagnostic procedure for localization of PA is developed, namely, adrenal venous sampling under continuous infusion of adrenocorticotropic hormone (ACTH) and administration of angiotensin II receptor blocker (AVS with ACTH and ARB), and the efficacy of this procedure is confirmed in the case of a 37-year-old male suspected of having PA.

[The long-term administration of dexamethasone for the differentiation of the 4 types of hyperaldosteronism].

It is concluded that the measurement of s-K and diurnal rhythm of PAC before and after Dex administration are useful for discriminating APA and IHA and it is suggested that UAH is a precedent pathophysiological condition of aldosterone-producing adenoma in the adrenal cortex.

Association of kidney function with residual hypertension after treatment of aldosterone-producing adenoma.

  • V. WuS. Chueh K. Wu
  • Medicine
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2009
Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy, and Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension.



The plasma aldosterone response to angiotensin II infusion in aldosterone-producing adenoma and idiopathic hyperaldosteronism.

The sensitivity of aldosterone-producing adenomas to angiotensin II is significantly less than that of the hypersecreting adrenal tissue in patients with idiopathic hyperaldosteronism, and this difference in adrenal sensitivity might in part explain the difference in the response of plasma ald testosterone concentrations to upright posture in these two subsets of a Aldosterone with low renin activity.

Effect of angiotensin II and converting enzyme inhibitor (captopril) on blood pressure, plasma renin activity and aldosterone in primary aldosteronism.

The idea that idiopathic hyperaldosteronism is a clinical state different from that occurring in primary aldosteronist due to adenoma, and may be more closely related to essential hypertension, is supported.

Control of plasma aldosterone in primary aldosteronism: distinction between adenoma and hyperplasia.

Comparisons of the 9 cases of “typical” APA with the 7 patients with IAH showed other differences, and the diurnal curve of plasma aldosterone in APA showed a decline from early morning to late evening, parallel with falling plasma cortisol, regardless of stimulation of renin by posture, sodium depletion or spironolactone.

Effect of upright posture on the aldosterone responses to dopamine, metoclopramide, angiotensin II, and adrenocorticotropin.

The effect of upright posture on aldosterone responses to low infusion rates of DA, to the DA antagonist metoclopramide (M), and to AII and ACTH is investigated to conclude that upright posture sensitizes the adrenal cortex to inhibition of a Aldosterone secretion by DA without affecting other modifiers of ald testosterone secretion.

Angiotensin-responsive aldosterone-producing adenoma masquerades as idiopathic hyperaldosteronism (IHA: adrenal hyperplasia) or low-renin essential hypertension.

A subgroup of patients with aldosterone-producing adenoma (APA) who are responsive to angiotensin who are important not to misdiagnose this subgroup as bilateral hyperplasia or low-renin essential hypertension.

Circadian rhythm and effect of posture on plasma aldosterone concentration in primary aldosteronism.

It is suggested that aldosterone secretion is under continuous ACTH control regardless of posture in patients with adenoma, whereas persistent adrenal responsiveness to small increments in renin and/or potassium mediate the postural increase in plasma ald testosterone in patientsWith hyperplasia.

Dietary Sodium Change in Primary Aldosteronism Atrial Natriuretic Factor, Hormonal, and Vascular Responses

Systemic arterial blood pressure rose to a highly significant extent after dietary sodium content was increased, thus casting doubt on a role for ANF as an endogenous long-term modulator of systemic blood pressure and peripheral α-adrenergk sensitivity in patients with primary aldosteronism.

Primary aldosteronism due to unilateral adrenal hyperplasia.

A 45-yr-old man with hypertension, hypokalemia, low plasma renin, and hyperaldosteronism was studied, and three years later, the patient is normotensive without drugs.

Circadian rhythm of plasma aldosterone concentration in patients with primary aldosteronism.

The data suggest that patients with primary aldosteronism have a circadian rhythm of plasma aldosterone mediated by changes in ACTH, similar to the circadian pattern of plasma cortisol in the same patients.