Hypertension caused by an aldosterone-secreting adenoma. Occurrence in a 7-year-old child.

A 7-year-old girl had hyperaldosteronism due to an adrenal cortical adenoma, a rare, surgically remediable cause of hypertension. Although the plasma potassium concentration was only slightly below normal, and the plasma aldosterone concentration was in a high normal range, the consistently suppressed plasma renin activity suggested primary aldosteronism. This diagnosis was confirmed by the failure of saline infusion to lower the plasma aldosterone concentration. Glucocorticoid-remediable hyperaldosteronism was excluded when dexamethasone did not reduce the high plasma aldosterone concentration. An enlarged left adrenal gland was observed in the computed tomographic scan, and blood from the left adrenal vein contained much more aldosterone than blood from the right adrenal vein. Surgical excision of the left adrenal gland, containing an adenoma, was followed by a return of BP and biochemical measurements to their normal ranges. This case demonstrated the importance of a rational systematic approach in the evaluation of children with sustained unexplained hypertension and the need to obtain plasma renin activity values when either hypokalemia is present or initial investigations fall to provide a diagnosis.