This evidence highlights the high prevalence of poor adherence in patients with resistant hypertension and the need for caution in using invasive approaches. These preliminary data require validation in a larger cohort, to confirm the need for TDM in routine clinical practice.
Objective: Our objective was to investigate psychological correlates in a population with primary aldosteronism (PA) using methods found to be sensitive and reliable in psychosomatic research.Methods: Twenty-three PA patients (12 male, 11 female; mean age 50 Ϯ 9 yr) were compared with 23 patients with essential hypertension (EH) (15 male, eight female; mean age 47 Ϯ 8 yr) and 23 matched normotensive subjects. A modified version of the Structural Clinical Interview for DSM-IV, a shortened version of the structured interview for the Diagnostic Criteria for Psychosomatic Research, and two self-rating questionnaires, the Psychosocial Index and the Symptom Questionnaire, were administered.Results: Twelve of 23 patients with PA (52.2%) suffered from an anxiety disorder compared with four of 23 with EH (17.4%) and one control (4.3%) (P Ͻ 0.001). Generalized anxiety disorder was more frequent in PA than in EH patients and controls (P Ͻ 0.05). As assessed by Diagnostic Criteria for Psychosomatic Research, irritable mood was more frequent in PA and EH compared with controls (P Ͻ 0.05) but did not differentiate PA from EH. According to Psychosocial Index results, patients with PA had higher levels of stress (P Ͻ 0.01) and psychological distress (P Ͻ 0.01) and lower level of well-being (P Ͻ 0.05) than controls. Compared with EH patients, PA patients had higher scores in stress subscale (P Ͻ 0.05). The Symptom Questionnaire showed higher levels of anxiety (P Ͻ 0.01), depression (P Ͻ 0.01) and somatization (P Ͻ 0.01) and lower physical well-being (P Ͻ 0.05) in PA than controls.
Conclusion:A role of mineralocorticoid regulatory mechanisms in clinical situations concerned with anxiety and stress is suggested. (J Clin Endocrinol Metab 96: E878 -E883, 2011) L ittle is known about the psychological aspects of primary aldosteronism (PA). Three case reports on Conn's syndrome presenting as depression have been published (1-3). Sonino et al. (4) investigated the presence of psychiatric disorders and subclinical psychological syndromes in 10 consecutive newly diagnosed patients with PA. Seven of the 10 patients suffered from anxiety disturbances (in most of the cases generalized anxiety disorder). Demoralization occurred in five cases and in one of them was associated with major depressive disorder (4). Sukor et al. (5) assessed quality of life in 22 patients with PA who underwent unilateral laparoscopic adrenalectomy. Significant improvements were observed after 3 months in dimensions of quality of life, such as mental health and vitality, at both 3 and 6 months assessment. In the former study (4), however, a chance association between anxiety and aldosteronism could not be excluded, and in the latter (5), nonspecific psychological effects secondary to surgery
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