Clinical Characteristics and Long-Term Outcome of Primary Aldosteronism in a Norwegian Population

Abstract

Primary aldosteronism (PA) is the most common cause of secondary hypertension (HT). We describe here clinical characteristics, diagnostic procedures, and long-term outcomes in a Norwegian population. All suspected PA patients investigated at a tertiary centre from 1998–2012 were retrospectively evaluated. Inclusion criteria were verified PA after confirmatory testing or otherwise considered highly likely PA. Clinical, biochemical, radiological, and adrenal vein sampling (AVS) findings were analysed. Surgically removed adrenals were re-evaluated histopathologically and tested for somatic mutations. All patients still alive by August 2014 were invited to a follow-up visit. One-hundred and eight patients were included, of whom 85% had a history of hypokalaemia. PA was verified by confirmatory testing in 83 (77%), and AVS performed in 95 (88%) patients. The proportion with AVS-confirmed bilateral PA increased during the study period. Sixty-eight patients (63%) underwent adrenalectomy. KCNJ5 mutations were found in 30% of the surgical specimens and were associated with female sex and a florid PA phenotype. Follow-up visits were undertaken in 73/108 (68%), of whom 52 adrenalectomised. After adrenalectomy, 83% were biochemically cured of PA, but only 21% were cured for HT. Female sex, a verified adenoma, and KCNJ5 mutations were associated with cure of HT. In conclusion, the majority of our patients had unilateral PA and hypokalaemia, indicating that patients with bilateral and milder PA may still be underdiagnosed. Female sex, a histopathological adenoma, and the presence of KCNJ5 mutations predicted cure of HT after adrenalectomy, but the overall cure rate of HT was low.

Surgical Outcomes of Aldosterone-Producing Adenoma on the Basis of the Histopathological Findings

“…In previous studies, surgical outcomes of APA patients were mainly based on the histopathology of HE staining or AVS instead of functional pathology ( 7 , 12 – 14 , 18 , 19 ). A study from Mayo Clinic observed the outcome of unilateral adrenalectomy in 263 patients with presumptive unilateral disease diagnosed by imaging and AVS.…”

“…In our study, the predictive factors of postoperative clinical cure of patients included female gender, shorter duration of hypertension and lower level of blood pressure. Citton et al also found that female gender, a fewer number of antihypertensive drugs, and a shorter duration of hypertension were the main predictors of hypertension cure ( 18 ). In addition, the present study developed a model, integrating multiple predictors to predict the prognosis of surgery, which is easy to use and is more accurate than single clinical parameter for the prediction of surgical outcomes.…”

Immunohistochemical staining seems mandatory for individualizing and shortening follow‐up in unilateral primary aldosteronism

“…This results from the severe underdiagnosis of PA in Iceland. 19 Finally, we did not search for somatic mutations, such as KCNJ5, a suggested predictor of cure after adrenalectomy 29,30 although controversial. 23…”

Hormone and Metabolic Research: 50 Years of Research

“…Within the last couple of years, a special focus was given to endocrine tumors, e. g. of the neuroendocrine system including pituitary tumors and pheochromocytoma / paraganglioma. In addition, three issues were published on primary hyperaldosteronism focusing on the genetic cause of the disease as well as diagnostic and therapeutic options [2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”