Comparison of Confirmatory Tests for the Diagnosis of Primary Aldosteronism

Mulatero, Paolo; Milan, Alberto; Fallo, Francesco; Regolisti, Giuseppe; Pizzolo, Francesca; Fardella, Carlos E.; Mosso, Lorena; Marafetti, Lisa; Veglio, Franco; Maccario, Mauro

doi:10.1210/jc.2006-0078

Cited by 171 publications

(157 citation statements)

References 24 publications

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“…Our results indicate that some patients with primary aldosteronism might differ in some respects from the majority of patients with this endocrine disorder, inasmuch as development of intrarenal vascular damage, occurring as a complication of severe hypertension, may lead to a reversal of renin suppression, a condition that may veil the typical hormonal characteristics of this clinical condition. Although, as in our patients, the aldosterone-torenin ratio can be increased even in the absence of a suppressed plasma renin, this possibility should be kept in mind while performing the diagnostic workup of hypertensive patients, and appropriate use of well-established confirmatory tests, such as the saline infusion or fludrocortisone test, should be considered (45).…”

Section: Discussionmentioning

confidence: 72%

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Catena¹,

Colussi²,

Nadalini³

et al. 2007

Clinical Journal of the American Society of Nephrology

102

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Background: The renal damage that is present in primary aldosteronism might reflect functional and potentially reversible abnormalities that are initiated by glomerular hyperfiltration. The aim of this study was to investigate the relationships of plasma renin and aldosterone concentrations with renal outcomes after treatment of primary aldosteronism.Design, setting, participants, and measurements: Fifty-six consecutive patients who had primary aldosteronism and were recruited in a university center were studied. Patients were prospectively followed after either surgical or medical treatment for a mean of 6.2 yr, during which they received antihypertensive drugs to reach a target BP of <140/90 mmHg.Results: At baseline, patients with primary aldosteronism had higher creatinine clearance and albuminuria than 323 patients with essential hypertension and 113 normotensive individuals. In patients with primary aldosteronism, plasma active renin levels that were higher than the lower limit of detection (2.5 pg/ml) were associated with higher BP, plasma potassium, and albuminuria and lower creatinine clearance. Plasma aldosterone concentrations that were higher than the median value (225 pg/ml) were associated with lower plasma potassium and higher creatinine clearance. Creatinine clearance was correlated directly with plasma aldosterone and inversely with renin. During follow-up, patients with higher baseline plasma renin required use of more antihypertensive drugs to obtain BP control and had a smaller early decline in albuminuria than did patients with suppressed renin.Conclusions: Escape of renin from suppression by excess aldosterone is associated with evidence of more severe renal damage in patients with primary aldosteronism and predicts less favorable outcomes after treatment.

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Section: Discussionmentioning

confidence: 72%

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Catena¹,

Colussi²,

Nadalini³

et al. 2007

Clinical Journal of the American Society of Nephrology

102

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“…20 Briefly, patients were screened using the serum aldosterone:plasma renin activity (PRA) ratio (ARR), and PA was confirmed using the intravenous saline load test. 21 All of the patients with confirmed PA underwent computed tomography scanning and AVS. AVS was considered successful if the adrenal vein/inferior vena cava cortisol gradient was Ն3 22 (or Ն2 before 2008); lateralization was considered when the aldosterone:cortisol ratio from one adrenal was Ն4 times that of the other adrenal gland (lateralization ratio).…”

Section: Diagnosis Of Pamentioning

confidence: 99%

Prevalence and Characteristics of Familial Hyperaldosteronism

Mulatero¹,

Tizzani²,

Viola³

et al. 2011

Hypertension

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126

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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.

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“…The proportion of NC-PA was even higher if we excluded from the study those patients (case numbers 6,8,14,18,23,32, and 33) in whom an aldosteronesecreting tumor was not excluded with certainty (i.e. patients with an adrenal mass and a not-performed or not-successful AVS).…”

Section: Resultsmentioning

confidence: 99%

“…AVS could not clearly demonstrate a lateralization of aldosterone secretion (lateralization index !4 or selectivity index !3) (11) in any of the remaining 20 subjects. In seven out of the 13 patients with unilateral or bilateral lesions (case numbers 6,8,14,18,23,32, and 33), we could not get a more precise diagnosis by AVS (four refused and three had an unsuccessful procedure); nevertheless, we decided to include them in the study.…”

Section: Measures At Diagnosismentioning

confidence: 99%

“…At reevaluation, for obvious reasons of costs and convenience, we had always chosen to run the NaCl test, now considered by most authors a reliable alternative to the more expensive and complex fludrocortisone test (11). Moreover, according to our experience, the NaCl test has proved to perform no differently to the fludrocortisone test (14).…”

Section: Nc-pa (Nz26)mentioning

confidence: 99%

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Long-term re-evaluation of primary aldosteronism after medical treatment reveals high proportion of normal mineralocorticoid secretion

Lucatello

Benso²,

Tabaro³

et al. 2013

European Journal of Endocrinology

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Objective: In most cases of primary aldosteronism (PA), an adrenal aldosterone-secreting tumor cannot be reasonably proven, so these patients undergo medical treatment. Controversial data exist about the evolution of PA after medical therapy: long-term treatment with mineralocorticoid antagonists has been reported to normalize aldosterone levels but other authors failed to find remission of mineralocorticoid hypersecretion. Thus, we planned to retest aldosterone secretion in patients with medically treated PA diagnosed at least 3 years before. Design: Retrospective, cross-sectional study. Methods: The same workup for PA as at diagnosis (basal aldosterone to renin activity ratio (ARR) and aldosterone suppression test) was performed after stopping interfering drugs and low-salt diet, in 34 subjects with PA diagnosed between 3 and 15 years earlier, by case finding from subgroups of hypertensive patients at high risk for PA. Criteria for persistence of PA were the same as at diagnosis (ARR (pg/ml per ng per ml per h) O400, aldosterone O150 pg/ml basally, and O100 pg/ml after saline infusion) or less restrictive. Results: PA was not confirmed in 26 (76%) of the patients and also not in 20 (59%) using the least restrictive criteria suggested by international guidelines. Unconfirmed PA was positively associated with female sex, higher potassium levels, longer duration of hypertension, and follow-up, but not with adrenal mass, aldosterone levels at diagnosis, and treatment with mineralocorticoid antagonists. Conclusions: This study suggests that mineralocorticoid hyperfunction in patients with PA after medical treatment may decline spontaneously. Higher potassium concentration and duration of treatment seem to increase the probability of this event.

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Comparison of Confirmatory Tests for the Diagnosis of Primary Aldosteronism

Abstract: This study demonstrates that the iv SLT is a reasonably good alternative to the more expensive and complex FST for the diagnosis of PA after a positive screening test.

Cited by 171 publications

References 24 publications

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Relationships of Plasma Renin Levels with Renal Function in Patients with Primary Aldosteronism

Prevalence and Characteristics of Familial Hyperaldosteronism

Long-term re-evaluation of primary aldosteronism after medical treatment reveals high proportion of normal mineralocorticoid secretion

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