Side effects of parenteral long-acting phenothiazines.

There are other intriguing features of the present case. At no time was the patient hypertensive, in contrast to the usual situation in Conn's syndrome or bilateral adrenal hyperplasia. As Conn (1964) pointed out, however, the rise in pressure is variable and in the early stages may be minimal. The observations on blood pressure harmonize also with the measurements of plasma renin activity. In Conn's syndrome or bilateral hyperplasia renin activity is usually depressed, but in this patient the activity of the renal enzyme was normal. Again it must be postulated that the duration and degree of hyperaldosteronism were insufficient to depress plasma renin activity, offsetting the aldosterone effect. (Brunner et al., 1970). However the biochemical changes are explained, the possibility that a malignant adrenal lesion may be producing changes similar to those produced by a benign adenoma or bilateral hyperplasia makes it reasonable to advocate that detailed steroid studies should be done in all such patients; that the tumour, if present, should be located; and that if necessary one or both adrenal glands should be removed. Spironolactone has a place in the diagnosis and investigation of primary aldosteronism but should not be used as a definitive treatment.