[Clinical observation of 12 cases of primary aldosteronism, special reference to the diagnostic problem (author's...

Twelve cases of patients with primary aldosteronism (PA) who admitted to Hokkaido University Hospital from 1965 to 1975 were studied. 1. Attention should be paid for the existence of PA as a frequent cause of juvenile hypertension in female, since female were frequently than in male (11 cases of female to 1 case of male) and 10 of 12 patients with PA were pointed out to have high blood pressure at the age of under 40. 2. Periodic paralysis as a main clinical symptom with PA were more frequent in our study than in the reports of other countries, which might be due to a large amount of salt intake in Japanese. 3. In accordance with the rapid progress of hormonal estimation for plasma renin activity (PRA) and plasma aldosterone concentration (PAC), the usefulness of potassium clearance test by the use of sodium thiosulfate became less worth. 4. It was impossible to differentiate primary aldosteronism from low renin essential hypertension by means of PRA after the stimuli of intravenous injection of furosemide and walking, but it could be differentiated after 3 days of sodium restriction, 3 days of administration of hydrochrolothiazide (75 mg/day) and 3 hours of walking. 5. With the long-term use of diuretics and various kinds of antihypertensive drugs in the treatment of high blood pressure in patients with PA, normal basal level and responsiveness of PRA were observed. Therefore no patient should be put through renin and aldosterone studies while on diuretics and antihypertensive drugs. 6. The 131I-19-iodocholesterol adrenal scintigraphy is a first choice method for the localizing diagnosis of PA because of inherent disadvantages in selective adrenal venography or in the determination of PAC in adrenal venous blood obtained against by catheterization of the adrenal veins.