Bilateral adrenal hyperplasia; a common cause of drug-refractory hypertension yet amenable to medical treatment
Over the past 4 and 1/2 years, a total of 97 patients had hypertension yet lacked clinical, laboratory and radiological evidence of renal, renovascular and endocrine disease were investigated for A/R ratio. High A/R was detected in 30 patients. Five patients had unilateral adrenal adenoma and 1 had cancer while 24 patients (24.7%) had bilateral enlargements indicating bilateral adrenal hyperplasia (BAH). Our study has shown that BAH is: (a) easily diagnosed with a combination of A/R ratio and CT scan of the adrenal gland, (b) responsible for 24.7% of hypertension cases, (c) associated with moderate to severe hypertension that may require 2-4 antihypertensives, (d) associated with hypokalemia in only in 54% of the cases, (e) not controlled with a single daily dose of Spironolactone (S) and ½ the cases require 50 mg/day. Moreover, it has shown that S treatment was not associated with significant hyperkalemia yet gynecomastia and erectile dysfunction were common side effects. Interestingly; and despite normalization of A/R ratio, most patients continue to require antihypertensive drugs though the number and dosage were less. The latter phenomenon was more evident in those with higher initial A/R ratio and longer duration of hypertension. Nephroangiosclerosis is the most plausible explanation for it. In conclusion; BAH is not a rare disease and should be considered in cases of refractory hypertension.
Keywords: Aldosterone, Aldosterone/Renin ratio, hypertension, Spironolactone.
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