Primary Aldosteronism with Suppressed Plasma Renin Activity Due to Bilateral Nodular Adrenocortical Hyperplasia

Abstract

A 66-year old Negro woman with hypertension was treated with Na restriction for a number of years. Careful observation following an attack of Landry-Guillaine-Barre polyneuropathy, revealed: intermittent hypokalemia, elevated secretion of aldosterone, normal cortisol secretion rate and suppressed plasma renin activity; which prompted surgical exploration for an aldosterone secreting tumor. Bilateral nodular adrenocortical hyperplasia with atrophy of much of the zona glomerulosa were the operative findings. Histologically the nodules resembled normal cells of the zona fasciculata. No aldosterone was found in the adrenal tissue. The etiology for the aldosteronism in this patient may have been chronic Na restriction with eventual autonomous adrenal hyperfunction, as has been reported for other chronically over-stimulated endocrine glands.