In cases of neoplastic primary aldosteronism, adenomas make up the vast majority of cases, while carcinomas are quite uncommon. Aldosteronoma often presents as a single, well-circumscribed unilateral adrenocortical lesion. The size of these lesions ranges from 0.5 to 6 cm in size.
The aldosteronoma possesses a golden-yellow tint on the sliced surface, while in a few cases, the color is light to dark tan. The presence of black adenomas in patients with primary aldosteronism is highly unusual. Necrosis or bleeding foci are not mostly seen. Aldosteronoma is believed to be solely responsible for aldosterone production.
Adrenal tumors that produce excessive levels of aldosterone are known as aldosterone as. Aldosterone typically controls blood pressure, potassium and sodium levels, and the body’s fluid balance. Newly elevated blood pressure and low potassium levels are common complaints of individuals who visit their doctor because of increased aldosterone production by the adrenal glands or an adrenal nodule.
A common age range for aldosteronoma is between 30 and 60, with equal prevalence in both men and women. Hypertension is a common medical condition. Although up to 38% of individuals possess normal potassium levels, the majority develop hypokalemia, which is frequently linked with the following symptoms:
- A lack of strength in the muscles.
- Increased thirst (polydipsia).
- A greater need to urinate (polyuria)
- Urination during the night (nocturia)
Hyperaldosteronism is caused by excessive aldosterone production by the adrenal glands. Aldosteronoma (Primary hyperaldosteronism) results from an issue with the adrenal glands. The majority of adrenal tumors are noncancerous.
The presence of high amounts of aldosterone is mostly linked with high blood pressure as well as low potassium levels. Low potassium levels often result in episodes of transient paralysis, tingling, muscle spasms, and weakness.
Aldosteronomas are often totally encapsulated and tiny, measuring less than 2 centimeters in diameter and weighing less than 50 grams. Except for black adenomas, the cut surfaces are often solid, uniform, golden yellow or yellow-brown, and free of necrosis or bleeding. Similarly, adrenal cortical tumors can replicate the appearance of either the zona fasciculata or the zona glomerulosa, or a combination of the two, when viewed with a microscope.
Mitoses are extremely uncommon, however, they are more prevalent in pediatric malignancies than they are in adult tumors. Adrenocortical neoplasms come in a wide range of morphologies, from those containing myelolipoma foci to black adenomas containing lipofuscin or neuromelanin to corticomedullary mixed tumors displaying a combination of adrenocortical and adrenomedullary differentiation.
Aldosteronoma is diagnosed when aldosterone levels are high and renin levels are low, and the ratio of aldosterone to renin is at least 20:1. Laboratory tests are used to determine the diagnosis. The next step is to obtain imaging if it hasn’t previously been done, and in most situations, adrenal vein sampling, an interventional radiology technique, is carried out.
Finding the underlying etiology, be it extra-adrenal, bilateral, or unilateral, is the only way to effectively treat this condition. Adrenal adenomas are generally difficult to detect because their maximal dimensions are often less than 15 mm. Numerous techniques are often utilized, including ultrasonography, selective venous sampling, computed tomography, magnetic resonance imaging, and scintigraphy.
The source of excess aldosterone in the adrenal gland is determined by an adrenal vein sample. An overabundance of aldosterone is produced by both adrenal glands in some people. As surgical removal of both adrenal glands is generally not preferred, these patients are treated with drugs like spironolactone, Aldactone, or eplerenone.
Patients with excessive aldosterone production from a single gland are often advised to undergo surgery. The majority of surgical procedures are performed laparoscopically (minimally invasively) through a series of tiny incisions. In most situations, nodules that produce aldosterone are completely safe, but in extremely unusual circumstances, they become cancerous. The majority of aldosteronomas are only one to two millimeters in size.