Bilateral adrenal hyperplasia as a cause of primary aldosteronism with hypertension, hypokalemia and suppressed renin activity

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      A fifty-six year old man presented with benign hypertension, hypokalemia and overproduction of aldosterone which persisted on a high sodium intake. Urinary excretion of cortisol and 17-ketosteroids was persistently normal. Plasma renin was below normal, even with sodium deprivation and the upright posture. Following bilateral total adrenalectomy, histologic examination revealed bilateral hyperplasia. No adenoma was found. The occurrence of aldosteronism resulting from bilateral adrenal hyperplasia suggests that all adrenal tissue is responding to a tropic stimulus, other than ACTH or angiotensin.
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