Urologic Oncology Branch National Cancer Institute Bethesda, Maryland 20892-1501
Address correspondence to: John L. Phillips, M.D., Urologic Oncology Branch, National Cancer Institute, Building 10, Room 2B47, Bethesda, Maryland 20892-1501.
To the editor:
The thoughtful and erudite comments of the reader well reflect the complexity involved in the diagnosis of aldosterone-secreting tumors in the atypical patient: those with normal computed tomography scans and/or equivocal bedside testing.
These difficult cases were referred to our institution for adrenal vein sampling, developed by our co-author, the late John L. Doppman, M.D. (see Memorial, Am J Roentgenol 2001, 176:457458).
In our experience, we found little difference in steroid levels or circadian patterns between the 2-h and 4-h morning time periods. We chose 2 h of ambulation because it was better tolerated by patients.
Steroid levels were determined by an outside analytical service that uses steroid-specific RIAs, Mayo Medical Laboratories. Over the years, we have found results to be very reproducible and highly consistent.
Patients were evaluated after 2 wk of cessation of antihypertensive medications, except in the case of spironolactone users, in which case we stopped therapy 6 wk before bedside testing.
All patients who underwent adrenalectomy for APA had either normalization of mean blood pressure values or improvement allowing single or double agent medical therapy.
Received April 25, 2001.