[Primary hyperaldosteronism--12 clinical cases]. / Hiperaldosteronismo primário--a propósito de 12 casos clínicos.

STUDY OBJECTIVES: To show clinical, biochemical, and morphological data of 12 patients with primary hyperaldosteronism: eight with an aldosterone-producing adenoma and four with adrenal hyperplasia. To compare clinical and biochemical parameters of the patients with adenoma and hyperplasia. For those with adenoma, to verify clinical and biochemical modifications after adrenalectomy. PATIENTS AND METHODS: In the 12 patients with hyperaldosteronism, retrospective analysis of clinical (age, sex, blood pressure), biochemical (plasmatic and urinary potassium, plasmatic aldosterone, plasma renin activity, and plasmatic aldosterone/renin activity ratio), and morphological (computed tomography, magnetic resonance, and norcholesterol scintigraphy) data was performed. RESULTS: 1--In the 12 patients with hyperaldosteronism (seven female), the age was 51.0 +/- 10.2 years (mean +/- standard deviation), the systolic pressure 200.9 +/- 34.5 mm Hg and the diastolic pressure 120.0 +/- 12.3 mm Hg. Hypertension was diagnosed 12.0 +/- 10.1 years before. As biochemical evidence, we found kalaemia of 3.06 +/- 0.28 and urinary potassium of 63.4 +/- 16.5 mEq/l, renin activity 0.98 +/- 1.02 ng/ml/h, plasmatic aldosterone of 49.4 +/- 36.0 ng/dl, aldosterone/renin activity > 30 in 83% of the cases. As morphological evidence, computed tomography allowed diagnosis in nine patients, suggested it in two, being doubtful in one. Performed on four patients, resonance confirmed the tomography in three and was not contributive in one. The scintigraphy performed in four patients visualized two adenomas, was negative in one adenoma and in one hyperplasia. 2--In the eight patients with adenoma (six female), the youngest age and the highest diastolic pressure compared with patients with hyperplasia were statistically significant (p < 0.01 and 0.05). In the adenomas, the biochemical changes were more pronounced, but not statistically significant. The plasmatic aldosterone/renin activity ratio was also higher in the adenoma cases. 3--After the adrenalectomy, blood pressure became normal in five patients and was more easily therapeutically controlled in three. The average systolic and diastolic pressures decreased and the biochemical parameters became normal in all patients. The pre/post surgical modification of these parameters had statistical significance (systolic pressure decrease, p < 0.01; diastolic pressure decrease, p < 0.01; kalaemia increase, p < 0.001; renin activity increase, p < 0.01; aldosterone decrease, p < 0.02). The plasmatic aldosterone/renine activity ratio normalized in all patients. CONCLUSIONS: In diagnosing primary hyperaldosteronism, biochemical (kalaemia, urinary potassium, plasmatic aldosterone, renin activity, aldosterone plasmatic/renin activity) and tomography studies were important. On comparing the patients with hyperplasia with those with adenoma, we found that the latter are younger and exhibit higher diastolic pressure, both findings with statistical significance. After adenoma surgery, blood pressure became normal in five patients and improved in three, these findings, and the improvement of the kalaemia, plasmatic aldosterone, and renin activity parameters were statistically significant.

[Renovascular arterial hypertension. Importance of subtraction digital angiography in its diagnosis]. / Hipertensão arterial renovascular. Importância da angiografia digital de subtracção no seu diagnóstico.

The authors describe the material and the use method of intravenous digital subtraction angiography (IVDSA) before presenting the obtained results. The morphologic abnormalities of the renal arteries evidenced in 105 patients, are distributed by different pathologies such as: atherosclerosis 48 patients; fibromuscular dysplasia 27 patients; Takayasu's aortoarteritis 8 patients (7.6%); renal artery aneurysms 5 patients (4.8%); renal arterial emboli 1 patient (0.9%); iatrogenic 6 patients (5.7%); small kidney/hypoplastic renal artery 10 patients (9.5%). The authors draw also attention to an anatomic variant-the early bifurcation of the renal artery that should be evaluated under the pathophysiologic point of view. From this experience some conclusions emerge. The IVDSA permits the ambulatory screening of the renal arteries abnormalities with additive value in the cost/benefit ratio, that is translated in the increasing number of hypertensive patients who are identified as having renal artery abnormalities. The pathologies more frequently identified are the atherosclerotic in the old male and the fibromuscular dysplasia in the young female. The pathophysiologic significance of the early bifurcation of the renal artery needs further elucidation. According to the authors experience, the IVDSA has a paramount position and can even be the first test to be performed in the workup diagnostic approach to the hypertensive patient with moderate and strong suspection of RVH.

[Renovascular arterial hypertension. Importance of subtraction digital angiography in its diagnosis]. / Hipertensão arterial renovascular. Importância da angiografia digital de subtraccão no seu diagnóstico.

The objective of this study is to contribute to the positioning of the intravenous digital subtraction angiography (IVDSA) in the detection of morphologic abnormalities of renal arteries (RAs), susceptible to originate renovascular hypertension (RVH). The authors focus on the prevalence of RVH in the broad spectrum of systemic arterial hypertension. The definition of RVH is given and its diagnostic criteria are revisited. The angiography methods used in the evaluation of RAs morphologic abnormalities are described.

[Endocrine arterial hypertension. Pheochromocytoma]. / Hipertensão arterial endócrina. Feocromocitoma.

The authors emphasize some embryologic features of the chromaffin tissue as a basis of understanding of both the physiopathologic and clinical aspects of Pheochromocytoma. The appropriate sequence of diagnostic procedures was established in order to obtain clinical, biochemical and anatomical evidence of the tumor. It was concluded that an early diagnosis is mandatory in order to plan a curative surgical therapeutic approach. The embryologic and biochemical understanding of the Pheochromocytoma, in the context of the neuroendocrine tumors, allows a better rationale both for the diagnosis and therapy of this condition.

[Endocrine arterial hypertension. Primary hyperaldosteronism]. / Hipertensão arterial endócrina. Hiperaldoesteronismo primário.

The authors emphasize some adrenal embryologic features, mainly the cortex and medulla relationships. After brief considerations both on the biosynthesis and physiologic actions of aldosterone, the Primary Hyperaldosteronism physiopathology is described. The clinical, biochemical and anatomic evidences are presented as a basis for both the Syndrome diagnosis and its subtypes. The theoretical and practical aspects of the diagnostic tests are also referred as a basis for the rationale of the medical and surgical therapeutic approach. Some clinical and biochemical similar aspects between the Syndrome of Hyperaldosteronism and Essential Hypertension with low renin, are put forward as a possible physiopathologic link that could eventually contribute for a better understanding of the pathogenesis of Essential Hypertension.