Aldosteronoma

Classic triad of Conn's syndrome:
- Hypertension
- Hypokalemia
- Polyuria

Diagnostic test is PAC:PRA >30
- PAC: plasma aldosterone concentration
- PRA: plasma renin activity
- second confirmatory test is an aldosterone stimulation test (positive if urinary aldosterone level elevated during a saline infusion)

Workup: adenoma vs. hyperplasia
- important step in working patient with suspected aldosteronoma is to determine if you are dealing with a unilateral adrenocortical adenoma (2/3 of patients) or bilateral hyperplasia
- other very rare causes include adrenocortical carcinoma, angiotensin II responsive adenomas, familial hyperaldosteronism type I and type II
- this can be done by imaging - CT scan may show a solitary lesion

Indications for selective adrenal vein catheterization:
- sampling of adrenal vein may be necessary to localize adenoma.  placement of catheter confirmed by increase in cortisol concentration as compared to IVC
- looking for ~5 fold increase in aldosterone compared to the other side
- indicated with there is adrenal hypertrophy, bilateral nodules, no lesions

Pre-operative considerations:
- patient begins spironolactone pre-operatively to control hypertension and normalize potassium levels.
- other antihypertensives are added as needed
- stop spironolactone immediately post-op