Diagnosis and management of primary aldosteronism

Vilela, Leticia A P; Almeida, Madson Q.

doi:10.1590/2359-3997000000274

Cited by 60 publications

(51 citation statements)

References 52 publications

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“…PA is characterized by the autonomous production of aldosterone, which causes sodium retention, plasma renin suppression, endocrine hypertension, and cardiovascular damage, among other things [195]. Aldosterone is associated with key functions in the regulation of blood pressure, but has also been associated with causing inflammation, fibrosis, and blood vessel remodeling [196].…”

Section: Primary Aldosteronism (Pa)mentioning

confidence: 99%

Title: Human Serum/Plasma Glycoprotein Analysis by 1H-NMR, an Emerging Method of Inflammatory Assessment

Fuertes-Martín

Correig

Vallvé

et al. 2020

JCM

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Several studies suggest that variations in the concentration of plasma glycoproteins can influence cellular changes in a large number of diseases. In recent years, proton nuclear magnetic resonance (1H-NMR) has played a major role as an analytical tool for serum and plasma samples. In recent years, there is an increasing interest in the characterization of glycoproteins through 1H-NMR in order to search for reliable and robust biomarkers of disease. The objective of this review was to examine the existing studies in the literature related to the study of glycoproteins from an analytical and clinical point of view. There are currently several techniques to characterize circulating glycoproteins in serum or plasma, but in this review, we focus on 1H-NMR due to its great robustness and recent interest in its translation to the clinical setting. In fact, there is already a marker in H-NMR representing the acetyl groups of the glycoproteins, GlycA, which has been increasingly studied in clinical studies. A broad search of the literature was performed showing a general consensus that GlycA is a robust marker of systemic inflammation. The results also suggested that GlycA better captures systemic inflammation even more than C-reactive protein (CRP), a widely used classical inflammatory marker. The applications reviewed here demonstrated that GlycA was potentially a key biomarker in a wide range of diseases such as cancer, metabolic diseases, cardiovascular risk, and chronic inflammatory diseases among others. The profiling of glycoproteins through 1H-NMR launches an encouraging new paradigm for its future incorporation in clinical diagnosis.

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Section: Primary Aldosteronism (Pa)mentioning

confidence: 99%

Title: Human Serum/Plasma Glycoprotein Analysis by 1H-NMR, an Emerging Method of Inflammatory Assessment

Fuertes-Martín

Correig

Vallvé

et al. 2020

JCM

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“…Current confirmatory tests available include captopril challenge test, fludrocortisone suppression, oral sodium loading, and saline infusion testing. [20] If confirmatory testing is also positive, adrenal imaging is the next step in order to evaluate for large masses concerning for adrenocortical carcinoma and to help with procedural planning for interventional radiologists and general surgeons. CT is the preferred imaging modality as it is more cost-effective, and MRI has not been shown to offer advantages over CT.…”

Section: Discussionmentioning

confidence: 99%

The forgotten cause of hypertension: A case report and literature review of the prevalence, diagnosis and management of primary aldosteronism

Barlow

Abdel‐Latif

2018

CRIM

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In recent years, primary aldosteronism (PA) has been found to have a much higher prevalence than previously thought, especially among those with resistant hypertension. As hypertension has become a prominent public health issue affecting billions of people, the number of patients potentially affected by PA is a significant. Current medical and surgical therapies for PA are highly effective, and as untreated PA can lead to significant cardiovascular morbidity and mortality this stresses the importance of astute diagnosis and management on part of physicians. We present a case of a patient presenting with cardiovascular complications of untreated primary aldosteronism and review recent guidelines regarding screening, diagnosis, and management.Key Words: Conn's Syndrome, Adrenal hyperplasia, Primary aldosteronism, Hyperaldosteronism, Resistant hypertension BACKGROUNDPrimary aldosteronism (PA), or more commonly known as primary hyperaldosteronism, is the leading cause of secondary hypertension. [1,2] Once thought to be an uncommon disease, recent studies have shown that PA is increasingly common and present in anywhere from 5% to 10% of all those with hypertension. As hypertension is one of the most common chronic medical conditions, it is imperative that physicians involved in long-term management of these patients are familiar with recent guidelines surrounding PA diagnosis and management. When left undiagnosed, patients with primary aldosteronism have increased risk of cerebrovascular and cardiovascular events, which stresses the importance of proper screening, especially as current medical and surgical therapies are highly successful. We report a case of primary aldosteronism in a patient presenting with a cardiovascular event. Our case highlights the adverse complications of long standing primary aldosteronism and reviews the current literature regarding the prevalence of PA as well as its diagnosis and long-term management. CASE HISTORYA 65-year-old male with past medical history of poorly controlled hypertension presented to emergency department with acute onset substernal chest pain. His only known medical history was that of long-standing poorly controlled hypertension, that was self reported by the patient and confirmed by review of his previous blood pressure recordings and outpatient provider notes over the past several years in the hospital's electronic medical record. He was a lifelong non- Following the procedure, he remained hypertensive, despite up-titration to maximal doses of nifedipine, lisinopril and hydrochlorothiazide. He was also persistently hypokalemic with potassium levels ranging from 2.5 to 3.4 mmol/L, necessitating aggressive oral potassium supplementation. Given concern for secondary hypertension, plasma aldosterone and renin levels were drawn and were 17.5 ng/dl and 0.466 ng/ml/hr respectively, giving an elevated aldosterone renin ratio (ARR) of 37.5. A non-enhanced CT of the abdomen was performed and demonstrated slight enlargement and irregular thickening of the left adrenal...

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“…Уровень альдостерона, как обычно, измеряется по его концентрации в плазме (ng/ dL). К сожалению, этот простой тест не является строго спе цифичным, и наличие альдостеронизма должно подтверждаться путем проведения дополнительных исследований на возможность подавления уровня альдостерона с по мощью таких процедур, как введение обладающего высокой минералокортикоидной активностью флудрокортизона, а также путем солевой нагрузки или блокады ангиотензинконвертирующего фермента каптоприлом (Mulatero et al, 2006;Vilela, Almeida, 2017;Song et al, 2018). В норме эти воздействия должны подавлять секрецию альдосте рона.…”

Section: первичный альдостеронизм и соотношение альдостерон/ренинunclassified

Genetics and pathophysiology of low-renin arterial hypertension

Markel

2019

Vestn. VOGiS

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The review is devoted to the consideration of genetic determination and pathophysiology of one of the forms of hypertensive disease known as low-renin hypertension. At frst glance, the development of low-renin hypertension is “unnatural”, as renin, as a key enzyme of the renin-angiotensin system, which plays an important role in the development of hypertensive disease, is suppressed in low-renin hypertension. At the same time, the most important drugs actual in the treatment of hypertensive disease belong to the renin-angiotensin system blockers. This contradiction was resolved by a study of genetic and pathophysiological mechanisms of hypertension in some groups of patients with characteristic symptoms bringing these people together. Genetic studies of some recent decades using both family analysis and modern molecular genetic technologies have revealed the main mechanisms underlying low-renin hypertension, which can be classifed as certain syndromes with well-defned genetic and clinical features. These syndromes include cases of sporadically occurring somatic mutations in the cells of the adrenal cortex, which begin to produce aldosterone in increased amounts. Also, several oligogenic forms of low-renin hypertension were studied, some of which are associated with the hyperproduction of aldosterone, but in the others the development of low-renin hypertension was associated with mutations of genes involved in regulation of the functioning of the kidney ion channels. The discovery of some types of arterial hypertension with known mechanisms of their development is of paramount importance for medicine, as it allows for targeted efective therapy and in some cases for achieving a complete cure. However, the main contingent of patients with low-renin hypertension belongs to cases with unexplained etiology, as their development is associated with polygenic systems and with a signifcant inﬂuence of numerous environmental factors. The study of genetic and physiological mechanisms of various forms of low-renin arterial hypertension provides a good example of how penetration into the intimate mechanisms of the blood pressure regulation in each personal case makes it possible to identify some specifc syndromes and establish its fnal causes. It seems that progress in understanding the causes and mechanisms of essential hypertension lies along this way.

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Diagnosis and management of primary aldosteronism

Cited by 60 publications

References 52 publications

Title: Human Serum/Plasma Glycoprotein Analysis by 1H-NMR, an Emerging Method of Inflammatory Assessment

Title: Human Serum/Plasma Glycoprotein Analysis by 1H-NMR, an Emerging Method of Inflammatory Assessment

The forgotten cause of hypertension: A case report and literature review of the prevalence, diagnosis and management of primary aldosteronism

Genetics and pathophysiology of low-renin arterial hypertension

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