Background. Despite being widely recognized as the most common form of secondary hypertension, the true prevalence of primary aldosteronism (PA) and its main subtypes, aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH), among the general hypertensive population remains a matter of debate. Objectives. To determine the prevalence and clinical phenotype of PA in a large cohort of unselected hypertensive patients, consecutively referred to our Hypertension Unit, by 19 general practitioners from Torino, Italy. Methods. Patients were screened for PA using the serum aldosterone to plasma renin activity ratio after withdrawal from all interfering medications and PA was diagnosed according to the Endocrine Society guidelines. The diagnosis was confirmed/excluded by an i.v. saline infusion test or captopril challenge test and subtype differentiation was performed by adrenal CT scanning and adrenal vein sampling (AVS) using strict criteria to define both successful cannulation and lateralization of aldosterone production. Results. A total of 1,672 primary care hypertensive patients, 569 newly diagnosed hypertensives and 1,103 patients already diagnosed with arterial hypertension, were included in the study. A total of 99 patients (5.9%) were diagnosed with PA and conclusive subtype differentiation by AVS was made in 91 patients (27 patients with an APA and 64 patients with BAH). The overall prevalence of PA increased with the severity of hypertension, from 3.9% in hypertensives stage I to 11.8% in hypertensives stage III. Patients with PA more frequently displayed target organ damage and cardiovascular events compared to non-PA hypertensives, independent of confounding variables. Conclusions.The results from the present study demonstrated that PA is a frequent cause of secondary hypertension even in the general hypertensive population and indicates that the majority of hypertensive patients should be screened for PA. Keywords: Primary aldosteronism, aldosterone-producing adenoma, bilateral adrenal hyperplasiaAbbreviation list AC = aldosterone concentration APA = aldosterone-producing adenoma AVS = adrenal vein sampling ARR = serum aldosterone to plasma renin activity ratio BAH = bilateral adrenal hyperplasia CV events = cardiovascular events GP = general practitioner HT = hypertension LREH = low renin essential hypertensives MRA= mineralocorticoid receptor antagonist PA = primary aldosteronism PATO = primary aldosteronism in Torino Condensed AbstractThe prevalence of primary aldosteronism (PA) among general hypertensive population remains unknown. We screened 1,672 primary care hypertensives and 5.9% were diagnosed with PA (27 3 with an aldosterone-producing adenoma and 64 with bilateral adrenal hyperplasia). PA prevalence increased with the severity of hypertension, from 3.9% in hypertensives stage I to 11.8% in stage III. PA patients more frequently displayed target organ damage and cardiovascular events compared to non-PA hypertensives. The study demonstrated that PA is a frequent cause ...

Our findings confirm a negative effect of aldosterone excess on glucose metabolism and suggest that the recently reported higher rates of cardiovascular events in primary aldosteronism than in essential hypertension might be due to increased prevalence of the metabolic syndrome in the former condition.

This study demonstrates in a large population of patients the pathogenetic role of aldosterone excess in the cardiovascular system and thus the importance of early diagnosis and targeted PA treatment.

Abstract-In patients with primary aldosteronism, adrenal vein sampling (AVS) is considered the only reliable technique to distinguish between unilateral and bilateral autonomous production of aldosterone, but agreement is lacking on the best criteria indicating successful cannulation and lateralization. The objective of this study was to assess the impact of differing criteria for the successful cannulation and lateralization on the reproducibility of subtype diagnosis. Sixty-two patients with confirmed primary aldosteronism underwent AVS on 2 separate occasions, because the first was unsatisfactory. We compared the different diagnoses of primary aldosteronism subtype reached using AVS data assessed by permissive (type 1), intermediate (type 2), and strict (type 3) criteria. Although 91.1% of all of the (both first and second) AVSs were "successful" by type 1 criteria (50.8% by type 2 and 33.9% by type 3), in only 35.3% of patients was the diagnosis concordant between the first and second AVS. Type 1 criteria also led to a higher rate of diagnosis of unilateral primary aldosteronism (67.3% of successful procedures) than type 2 (36.5%) or type 3 (26.2%). There was considerable disparity in the diagnosis reached using the 3 different criteria, with concordance in only 32.2%. Using either type 1 or 2 criteria, the minimal adrenal/peripheral vein cortisol ratio necessary to obtain the same diagnosis in the first and second AVS procedures was Ն2.75. In conclusion, permissive criteria for successful cannulation and lateralization on AVS achieve poor diagnostic reproducibility and should be avoided. (Hypertension. 2010;55:667-673.)Key Words: endocrine hypertension Ⅲ primary aldosteronism Ⅲ aldosterone Ⅲ aldosterone-producing adenoma Ⅲ bilateral adrenal hyperplasia P rimary aldosteronism (PA) is currently believed to be the most frequent form of secondary endocrine hypertension, accounting for 5% to 10% of all hypertensive patients.

This study underlines the central role of AVS in the subtype diagnosis of PA. The use of the clinical criteria to distinguish between APA and BAH did not display a satisfactory diagnostic power.

Abstract-Primary aldosteronism (PA) is the most frequent cause of secondary hypertension, and patients display an increased prevalence of cardiovascular events compared with essential hypertensives. To date, 3 familial forms of PA have been described and termed familial hyperaldosteronism types I, II, and III (FH-I to -III). The aim of this study was to investigate the prevalence and clinical characteristics of the 3 forms of FH in a large population of PA patients. Three-hundred consecutive PA patients diagnosed in our unit were tested by long-PCR of the CYP11B1/CYP11B2 hybrid gene that causes FH-I, and all of the available relatives of PA patients were screened to confirm or exclude PA and, thus, FH-II. Urinary 18-hydroxycortisol and 18-oxocortisol were measured in all of the familial PA patients. Two patients were diagnosed with FH-I (prevalence: 0.66%), as well as 21 of their relatives, and clinical phenotypes of the 2 affected families varied markedly. After exclusion of families who refused testing and those who were not informative, 199 families were investigated, of which 12 were diagnosed with FH-II (6%) and an additional 15 individuals had confirmed PA; clinical and biochemical phenotypes of FH-II families were not significantly different from sporadic PA patients. None of the families displayed a phenotype compatible with FH-III diagnosis. Our study demonstrates that familial forms of hyperaldosteronism are more frequent than previously expected and reinforces the recommendation of the Endocrine Society Guidelines to screen all first-degree hypertensive relatives of PA patients. (Hypertension. 2011; 58:797-803.)Key Words: familial hyperaldosteronism Ⅲ endocrine hypertension Ⅲ primary aldosteronism Ⅲ aldosterone P rimary aldosteronism (PA) is the most frequent cause of secondary hypertension; it accounts for 5% to 15% of hypertensives, depending on the severity of the disease.

A role of mineralocorticoid regulatory mechanisms in clinical situations concerned with anxiety and stress is suggested.

Background: Adrenal vein sampling is considered the gold standard test to identify primary aldosteronism, the most frequent form of secondary hypertension. Technical difficulties with this procedure may be overcome by monitoring cortisol concentrations in the different sampling sites during catheterization. Methods: We applied a rapid automated cortisol assay performed on a benchtop immunoassay analyzer near the operating suite during the catheterization procedures in 5 hypertensive patients. A mean of 7.8 samples (range, 5–13) were collected from the vena cava as well as from right and left adrenal veins. Results: Cortisol concentrations measured by the rapid assay and by our routine method were comparable. Two of 5 patients were found to be affected by an aldosterone-producing adenoma and 3 of 5 by a bilateral adrenal hyperplasia. Cortisol determination during the adrenal vein sampling procedure allowed a successful cannulation in all patients, including a patient in whom it was necessary to cannulate 9 different candidate right adrenal veins before finding the correct one. Conclusions: Intraoperative cortisol assays appeared safe, reproducible, simple to perform, rapid, and cost-effective. The approach represents a service-oriented model for the laboratory and can provide valuable and timely information for improving the success rate of adrenal vein catheterization.