Hypertension caused by an aldosterone-secreting adenoma. Occurrence in a 7-year-old child
M. Bryer-Ash, D. M. Wilson, B. M. Tune, R. G. Rosenfeld, S. J. Shochat and J. A. Luetscher
A 7-year-old girl had hyperaldosteronism due to an adrenal cortical
adenoma, a rare, surgically remediable cause of hypertension. Although the
plasma potassium concentration was only slightly below normal, and the
plasma aldosterone concentration was in a high normal range, the
consistently suppressed plasma renin activity suggested primary
aldosteronism. This diagnosis was confirmed by the failure of saline
infusion to lower the plasma aldosterone concentration.
Glucocorticoid-remediable hyperaldosteronism was excluded when
dexamethasone did not reduce the high plasma aldosterone concentration. An
enlarged left adrenal gland was observed in the computed tomographic scan,
and blood from the left adrenal vein contained much more aldosterone than
blood from the right adrenal vein. Surgical excision of the left adrenal
gland, containing an adenoma, was followed by a return of BP and
biochemical measurements to their normal ranges. This case demonstrated the
importance of a rational systematic approach in the evaluation of children
with sustained unexplained hypertension and the need to obtain plasma renin
activity values when either hypokalemia is present or initial
investigations fall to provide a diagnosis.
