Plasma Concentration of Aldosterone, 18-Hydroxy-Deoxycorticosterone and Cortisol in Adrenal Veins of Patients with Low-Renin Hypertension

Plasma aldosterone, 18-OH-DOC and Cortisol concentrations in both adrenal veins were determined simultaneously in 21 hypertensive patients with suppressed plasma renin. In aldosterone producing adenoma group plasma aldosterone was 5.2 and 18-OH-DOC 3.6 times higher on the side of adenoma. In idiopathic hyperaldosteronism with bilateral adrenal hyperplasia the concentration of aldosterone and 18-OH-DOC was symmetrically high on both sides. In low-renin essential hypertension plasma 18-OH-DOC was high, aldosterone, however, was low in both adrenal venous effluent. Plasma concentration of cortisol in adrenal veins did not differ in these 3 groups. In Cushing's syndrome cortisol was high especially in the vein from the adrenal bearing an adenoma, aldosterone was low on both sides and 18-OH-DOC showed a wide scatter. Administration of synthetic ACTH increased aldosterone and 18-OH-DOC in a patient with aldosterone producing adenoma and in 2 patients with low-renin essential hypertension. Long-term treatment with Spironolactone lowered the adrenal venous plasma aldosterone. These results suggest that simultaneous determination of aldosterone, 18-OH-DOC and cortisol in adrenal veins is helpful in the differentiation of low-renin hypertensions and in localization of an adrenocortical adenoma. Changes of aldosterone and 18-OH-DOC in adrenal plasma after ACTH and Spironolactone demonstrate the ACTH dependence of aldosterone and 18-OH-DOC and the inhibiting effect of Spironolactone on aldosterone production. These changes are due to the direct influence of adrenal steroidogenesis and not only to changes in peripheral steroid metabolism.