[Adrenal hypertension]

Hypertension is surgically curable in a small number of patients with adrenal hypertension, mostly in patients with Conn's adenomas or pheochromocytomas. Patients with resistant hypertension and/or hypokalemia should be screened for primary aldosteronism. The aldosterone to renin ratio is a logical initial screening test. CT-scan and adrenal vein sampling help to distinguish between idiopathic hyperplasia and Conn's adenoma. Laparoscopic surgery is indicated when there is a history of severe or recent hypertension in patients with a typical Conn's adenoma or with a lateralizing adrenal vein sampling. The diagnostic test for pheochromocytoma is the determination of plasma or urinary metanephrines. Tumours can be located by CT-scan, magnetic resonance imaging and specific scintigraphies. One pheochromocytoma in 3 or 4 results from hereditary disease.