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The authors examine the various forms of primary hyperaldosteronism, outlining the most recent acquisitions in terms of etiopathogenesis and physiopathology. While Conn's original description of primary hyperaldosteronism is a syndrome based on corticoadrenal aldosteronesecreting adenoma, it was later seen that this condition could recognise other anatomic substrates, such as carcinoma and in particular bilateral corticoadrenal hyperplasia. A peculiar form of the latter can be suppressed with glucocorticoids sustained by an anomalous recombination of aldosterone-synthase and 11-beta-hydroxylase. The main focus in this paper is on clinical management, in particular the current diagnostic criteria which show that primary hyperaldosteronism affects a higher percentage of the hypertense population that was estimated in the past. Above all, the significance of the aldosterone/PRA (ARR) ratio in screening for this condition is discussed, above all in normokalemic forms, together with the role of molecular biology in identifying glucocorticoid-suppressible forms. Lastly, the principles of medical and surgical management are outlined, emphasising the role of laparoscopic surgery.

It was recently demonstrated that vascular endothelium produces many substances which modulate the vascular tone by acting locally (endothelium derived relaxing factor, angiotensin II, endothelin, prostacyclin). The authors review the physiological regulatory role of these substances and their involvement in cardiovascular diseases. They also consider the interaction between the endothelium derived factors and some cardiovascular drugs (such as calcium antagonists and ACE-inhibitors) and also the mechanisms of the possible protective action of these drugs on the vascular wall.

Hyperlactinemia is the most commonplace expression of hypophyseal pathology, above all in females, and is one of the most frequent causes of sexual disorders. The present study examined the etiopathogenesis of hyperprolactinemic syndromes and discusses their pathophysiology, paying special attention to neuroendocrine alterations in the presence of either prolactin-secreting adenoma or other forms of hyperprolactinemia. Their clinical manifestations are then described together with a detailed review of therapies, especially for prolactinoma. Both general opinion and the authors' personal point of view are reported regarding the indications for medical and surgical treatment for micro and macro-prolactinomas. Lastly, particular aspects are taken into consideration, such as the relationship between hyperprolactinemia and pregnancy, in the light of the most recent findings on the natural evolution of prolactinemia and the possibility of treatment using dopaminergic drugs.

The dopaminergic drugs have a pivotal role in the treatment of prolactin-secreting pituitary tumors. The Authors examine the available drugs and delineate the guidelines for the medical therapy of this neoplasia.

A family with Sipple's syndrome was studied over three generations. The syndrome is transmitted as a dominant autosomic hereditary trait with high penetrance and varying expressiveness. Our series include 13 patients of three generations: 1) husband and wife who were 1st degree cousins; 2) 4 sisters and 1 brother; 3) 5 sisters and 1 brother. In the first generation we did not find any sign that could be related to the syndrome, in the second generation 2 thyroid carcinomas and a pheochromocytoma were present, and in the third one 2 sisters had these neoplasias, one pheochromocytoma and the other thyroid cancer, another one had marfanoid habitus and the fourth one had pheochromocytoma. This series includes 11 subjects of the second and third generation; the Sipple's syndrome was present in 7 females. The incidence of the syndrome was 63.8% and present only in female subjects. The high incidence rate could be caused by the strict relation between the grandparents. The diffusion of this pathology may be related to the high penetrance of the gene(s) involved whereas the clinical variations may be interpreted to the variable expressiveness and, even more so, as evidence that the other manifestations of the syndrome may occur later in time.

In this review the physiologic role of the renin-angiotensin system in blood pressure regulation is discussed, and the alterations of the renin secretion in various forms of hypertension are examined. Furthermore a critical appraisal is made of the diagnostic and prognostic value of the plasma renin activity assay in hypertensive diseases.