Increased Diagnosis of Primary Aldosteronism, Including Surgically Correctable Forms, in Centers from Five Continents

Abstract

Primary aldosteronism (PA) is a common form of endocrine hypertension previously believed to account for less than 1% of hypertensive patients. Hypokalemia was considered a prerequisite for pursuing diagnostic tests for PA. Recent studies applying the plasma aldosterone/plasma renin activity ratio (ARR) as a screening test have reported a higher prevalence. This study is a retrospective evaluation of the diagnosis of PA from clinical centers in five continents before and after the widespread use of the ARR as a screening test. The application of this strategy to a greater number of hypertensives led to a 5- to 15-fold increase in the identification of patients affected by PA. Only a small proportion of patients (between 9 and 37%) were hypokalemic. The annual detection rate of aldosterone-producing adenoma (APA) increased in all centers (by 1.3-6.3 times) after the wide application of ARR. Aldosterone-producing adenomas constituted a much higher proportion of patients with PA in the four centers that employed adrenal venous sampling (28-50%) than in the center that did not (9%). In conclusion, the wide use of the ARR as a screening test in hypertensive patients led to a marked increase in the detection rate of PA.

Indicators of mineralocorticoid excess in the evaluation of primary aldosteronism

“…1,24,26 If the A PL /PRA ratio is used as a screening tool, the prevalence of PA in hypertensive patients varies between 9 and 13%, depending on the patient population. 2,3,6,13,27,28 However, there is still a lack of consensus regarding the appropriate method for determination of renin. PRA is dependent on the angiotensinogen concentration, as well as on renin concentration.…”

“…1 Using the aldosteroneto-renin ratio (ARR) as a screening tool, several studies found that PA is more frequent than previously assumed, affecting 1-13% of hypertensive individuals. [2][3][4][5][6] The different frequency found in these studies is because of the use of different screening tools, study designs and various study populations.…”

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

“…ARR may be significantly modified by a decrease in PRA levels, which does not necessarily imply the presence of autonomous ALD secretion; therefore many authors only take into account the ARR value when serum ALD levels exceed a specific concentration (8,9,13). Thus, we required an ALD concentration ≥ 15 ng/dL as a further requisite for applying ARR in our hypertensive patients.…”

Ventricular repolarization before and after treatment in patients with secondary hypertension due to renal-artery stenosis and primary aldosteronism

“…12 Patients with PA were recruited according to the following characteristics: consecutive patients referred to our Unit from 2002 to 2009 with an aldosterone to plasma renin activity ratio (aldosterone-renin ratio) 440, together with aldosterone levels 415 ng dl À1 , 13 underwent further evaluation with a salt loading test (2 l of 0.9% NaCl infused over 4 h). 14 Plasma aldosterone levels 45 ng dl À1 at the end of the test were deemed diagnostic for PA.…”

“…Lateralization was diagnosed when the aldosterone/ cortisol ratio from the adrenal was at least four times the ratio from the other adrenal gland. 13 A total of 60 and 160 hypertensive patients were diagnosed with RV and PA, respectively. After exclusion of patients with arrhythmias, bundle branch blocks, diabetes, obesity (body mass index X30) and those taking antiarrhythmic drugs of any class, 24 patients with RV (14 fibromuscular dysplasia and 10 atherosclerotic renal-artery disease) and 38 patients with PA (29 bilateral adrenal hyperplasia and 9 aldosterone-producing adenoma) were included in the study.…”