Primary Adrenal Hyperplasia (PAH)

PAH is a very uncommon cause of primary hyperaldosteronism. Rarely, a patient is found to have primary hyperaldosteronism. Imaging studies are performed but are negative. AVS is performed and a clear asymmetric secretion of aldosterone is found suggesting that the excess aldosterone is coming from only one adrenal gland. (Remember both glands over-secret aldosterone in IHA ). Despite negative imaging studies surgical resection is recommended based on AVS. Pathologic examination of the specimen reveals a diffuse over growth of tissue is the removed adrenal gland. This is known as primary adrenal hyperplasia (PAH). It is a clinical finding that can only be realized after surgery. Importantly, it is different from IHA in that PAH affects only one gland and is treated with surgery. IHA affects both glands and is treated medically. As with Conn’s syndrome, laparoscopic adrenalectomy is the standard of care. Surgical results are similar to surgical outcomes in Conn’s syndrome.