Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline

Funder, John W.; Carey, Robert M.; Fardella, Carlos E.; Gómez-Sánchez, Celso E.; Mantero, Franco; Stowasser, Michael; Young, William J.; Montori, Víctor M.

doi:10.1530/eje-09-0870

Cited by 196 publications

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“…Antihypertensive drugs were not discontinued before blood sampling in accordance with current guidelines, 19 which might have affected the measured values of ARR and may be a limitation of this study, but we believe that this approach is more easily generalizable and practical to adopt in everyday practice.…”

Section: Discussionmentioning

confidence: 99%

“…The blood samples for PRA and aldosterone were collected in the morning, after the patients have been seated for 5 to 15 minutes, without discontinuation of the medications. 19 Antihypertensive medications and all other medications were recorded at baseline, and patients did not change doses or the number of their antihypertensive medication throughout the trial. At every visit, patients were asked about the occurrence of any adverse effects of the medication.…”

Section: Methodsmentioning

confidence: 99%

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Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

Václavík

Sedlak²,

Plachý³

et al. 2011

Hypertension

266

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Abstract-There is currently limited data on which drug should be used to improve blood pressure (BP) control in patients with resistant hypertension. This study was designed to assess the effect of the addition of 25 mg of spironolactone on BP in patients with resistant arterial hypertension. Patients with office systolic BP Ͼ140 mm Hg or diastolic BP Ͼ90 mm Hg despite treatment with at least 3 antihypertensive drugs, including a diuretic, were enrolled in this double-blind, placebo-controlled, multicenter trial. One hundred seventeen patients were randomly assigned to receive spironolactone (nϭ59) or a placebo (nϭ58) as an add-on to their antihypertensive medication, by the method of simple randomization. Analyses were done with 111 patients (55 in the spironolactone and 56 in the placebo groups). At 8 weeks, the primary end points, a difference in mean fall of BP on daytime ambulatory BP monitoring (ABPM), between the groups was Ϫ5.4 mm Hg (95% CI Ϫ10.0; Ϫ0. R esistant hypertension is a common clinical problem faced by both primary care clinicians and specialists worldwide. It is defined as blood pressure (BP) that remains above goal despite the concurrent use of 3 antihypertensive agents of different classes prescribed at optimal dosages; one of the 3 agents used should be a diuretic. 1 The exact prevalence of resistant hypertension is not known, but it is estimated from large clinical trials to affect at least 10% to 15% of all hypertensive patients. 2,3 If no secondary cause of hypertension is found, the use of multidrug treatment regimens including 3, 4, or more antihypertensive drugs is usually necessary to lower BP and thus prevent future cardiovascular events. 4 Spironolactone is a mineralocorticoid receptor antagonist that was shown to lower BP effectively in both general hypertensive patients and patients with primary aldosteronism. 5-7 A number of small, uncontrolled trials showed the positive effect of small doses of spironolactone in lowering BP in patients with resistant arterial hypertension. 8 -11 In the nonrandomized post hoc analysis of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm, the addition of spironolactone to a triple-drug treatment led, during an average of 1.3 years of follow-up, to a significant decrease of systolic BP of 21.9 mm Hg and diastolic BP of 9.5 mm Hg. 12 However, evidence from randomized trials was lacking, and it was necessary to provide definite proof for the efficacy of spironolactone as an add-on treatment in resistant hypertension. 12,13 Therefore, we designed a prospective randomized trial to evaluate the effect of adding spironolactone in patients with resistant arterial hypertension. We decided to administer a low dose of spironolactone (25 mg/day) in the trial, since the effect of this dose seemed to be substantial

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

Václavík

Sedlak²,

Plachý³

et al. 2011

Hypertension

266

View full text Add to dashboard Cite

show abstract

“…Hypokalemia is usually observed in 9-37% of the patients. 12 Severe hypokalemia and associated hypokalemic paralysis are observed rarely. Hypertension, severe hypokalemia, hypokalemic paralysis, and hyporeninemic hyperaldosteronism were present in both of our cases.…”

Section: Discussionmentioning

confidence: 99%

“…19 PA should be investigated in cases of moderate or resistant hypertension; hypokalemia that is spontaneous or induced with diuretic therapy associated with hypertension; hypertension that accompanies adrenal incidentaloma; hypertension with positive family history of early-onset hypertension or with history of cerebrovascular events occurred below the age of 40; and among first degree relatives of hypertensive patients. 20 PA was considered in the differential diagnosis of both cases presented here due to observation of resistant hypertension in the first case and newly diagnosed hypertension accompanied by spontaneous hypokalemia in the second case.…”

Section: Discussionmentioning

confidence: 99%

Primary Aldosteronism Presented with Hypokalemic Paralysis: Two Case Reports

Oğuz¹,

Tüzün²,

Şahin³

et al. 2016

Turkiye Klinikleri J Intern Med

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A ldosterone is the principal mineralocorticoid in human. It's classical functions include regulation of extracellular volume and potassium homeostasis through its effects on the renal distal convoluted Primary Aldosteronism Presented with Hypokalemic Paralysis: Two Case Reports A AB BS S T TR RA AC CT T Primary aldosteronism may appear with various clinical presentations. Primary aldosteronism presented with hypokalemic paralysis is a very rare condition. Case 1; a 33-year-old male was admitted to the emergency department with the complaint of muscle weakness affecting all four extremities (quadriparesis). The patient had a history of hypertension and despite triple antihypertensive therapy his blood pressure was around 160/100 mmHg in follow-up evaluations. In physical examination, upper and lower ekstremity motor strength was 1/5 and deep tendon reflexes were absent. Case 2; a 39-year-old female were admitted to the hospital with the complaint of muscle weakness and pain, difficulty in stair climbing. She had no history of hypertension. In her physical examination; blood pressure was 150/80 mmHg. There was weakness in muscle strength especially in the lower extremities, and decrease in deep tendon reflexes. Hypokalemia (1.4 and 1.7 mEq/L, respectively) and hyporeninemic hyperaldosteronism were determined in both of the patients' laboratory examination. Adrenal adenoma was detected in the magnetic resonance images of both cases and improvements in hypokalemia and hypertension were observed following laparoscopic adrenalectomy for aldosterone producing adenoma. We believe that primary aldosteronism should be kept in mind in differential diagnoses of patients having muscle weakness, hypertension, and hypokalemia. K Ke ey y W Wo or rd ds s: : Hypokalemia; muscle weakness; hyperaldosteronism Ö ÖZ ZE ET T Primer aldosteronizm birçok klinik durumla prezente olabilir. Hipokalemik paralizi ile prezente olan primer hiperaldosteronizm çok nadir bir durumdur. İlk olgu; 33 yaşında erkek, acil servise dört ekstremitede yaygın kas güçsüzlüğü (quadriparezi) şikâyeti ile başvurdu. Hastanın hipertansiyon öyküsü vardı ve üçlü antihipertansif tedaviye rağmen kan basıncı 160/100 mmHg idi. Fizik muayenede üst ve alt ekstremite motor gücü 1/5 olarak değerlendirildi ve derin tendon refleksleri alınamadı. İkinci olgu; 39 yaşında kadın, kas güçsüzlüğü, merdiven çıkamama ve ağrı şika-yeti ile başvurdu. Hipertansiyon öyküsü olmayan hastanın başvurusunda kan basıncı 150/80 mmHg idi. Fizik muayenede özellikle alt ekstremitede daha belirgin olmak üzere dört ekstremitede de motor gücü ve derin tendon reflekslerinde azalma mevcuttu. Her iki olgunun laboratuvar incelemesinde, hipopotasemi (1,4 ve 1,7 mEq/L, sırasıyla) ve hiporeninemik hiperaldosteronizm saptandı. Bunun üzerine çekilen sürrenal manyetik rezonans görüntülemede her iki olguda da adrenal adenoma tespit edildi ve aldosteron üreten adenoma nedeniyle yapılan laparoskopik adrenalektomi sonrası hipopotasemi ve hipertansiyonun düzeldiği görüldü. Bu iki olgu ışığında biz, kas güçsüzlüğü...

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“…To date, the definitive diagnosis of PA is a multistep procedure requiring expert knowledge. For example, while adrenal venous sampling is recommended to assess whether aldosterone hypersecretion is lateralized in PA patients (19), this procedure is invasive, poorly standardized, and not widely available (20,21). Overall, compared with its importance as the major secondary cause of hypertension, the currently available tools for diagnosis and treatment of PA are cumbersome and quite inefficient.…”

Section: Clinical Backgroundmentioning

confidence: 99%

EJE Prize 2013: Regulation of aldosterone secretion: from physiology to disease

Beuschlein

2013

European Journal of Endocrinology

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Arterial hypertension is a major cardiovascular risk factor that affects between 10 and 40% of the population in industrialized countries. Primary aldosteronism (PA) is the most common form of secondary hypertension with an estimated prevalence of around 10% in referral centers and 4% in a primary care setting. Despite its high prevalence until recently, the underlying genetic and molecular basis of this common disease had remained largely obscure. Over the past decade, a number of insights have been achieved that have relied on in vitro cellular systems, wild-type and genetically modified in vivo models, as well as clinical studies in well-characterized patient populations. This progress has been made possible by a number of independent technical developments including that of specific hormone assays that allow measurement in small sample volumes as well as genetic techniques that enable high-throughput sequencing of a large number of samples. Furthermore, animal models have provided important insights into the physiology of aldosterone regulation that have served as a starting point for investigation of mechanisms involved in autonomous aldosterone secretion. Finally, national and international networks that have built up registries and biobanks have been instrumental in fostering translational research endeavors in PA. Therefore, it is to be expected that in the near future, further pathophysiological mechanisms that result in autonomous aldosterone secretion will be unraveled. European Journal of Endocrinology 168 R85-R93

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Case detection, diagnosis, and treatment of patients with primary aldosteronism: an Endocrine Society clinical practice guideline

Abstract: Ahead of Print article withdrawn by publisher.

Cited by 196 publications

References 0 publications

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

Addition of Spironolactone in Patients With Resistant Arterial Hypertension (ASPIRANT)

Primary Aldosteronism Presented with Hypokalemic Paralysis: Two Case Reports

EJE Prize 2013: Regulation of aldosterone secretion: from physiology to disease

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