Is There an Unrecognized Epidemic of Primary Aldosteronism? (Pro)

Kaplan, Norman M.

doi:10.1161/hypertensionaha.106.086116

Cited by 106 publications

(67 citation statements)

References 38 publications

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“…14 ARR has been proposed as the most sensitive screening test, 3,5,[11][12][13]15 but it has been criticized because it predominantly depends on low PRA values 5,9,16,17 and because of its low specificity. 18 For this reason combined criteria including also an aldosterone level above a minimal threshold have been proposed.…”

Section: -13mentioning

confidence: 99%

“…18 For this reason combined criteria including also an aldosterone level above a minimal threshold have been proposed. 5,11,16,18 However, all the biochemical parameters are affected by a significant variability and the laboratory screening still requires a definite standardization. Aldosterone levels are known to vary considerably in the same subject and various factors have been identified that affect this variability; among them sodium and potassium balance, posture, circadian rhythm and drug treatment are well known.…”

Section: -13mentioning

confidence: 99%

“…No effects were observed for cutoffs based on PRA. The same was true for ARR except for a value of 430, when: (1) a minimum PRA value of 0.5 ng ml À1 h À1 was used to calculate the ratio, as proposed by Pimenta and Calhoun 5,16 or (2) when ARR was used in combination with a value of plasma aldosterone415 ng 100 ml À1 , as suggested by other authors. 11,16,18 Significant positive correlations were observed for pooled data between aldosterone and both PRA and …”

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confidence: 90%

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The ovarian cycle as a factor of variability in the laboratory screening for primary aldosteronism in women

et al. 2008

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Primary aldosteronism is increasingly investigated in hypertension being associated with an elevated cardiovascular risk. Aldosterone has been reported to increase in the luteal phase in normal women but to our knowledge the influence of the ovarian cycle on the first screening for primary aldosteronism (that is, on the levels of plasma aldosterone and its relationship to PRA levels) was never investigated. We measured hormonal levels during one cycle in 26 low-renin mild hypertensive outpatients. LH, FSH, 17 b-estradiol, progesterone, aldosterone and PRA were assayed at the seventh, fourteenth, twenty-first and twenty-eighth days of the cycle after 30 min of recumbency. Aldosterone and PRA increased from the seventh (follicular phase) to twentyfirst day (luteal phase) from 11.2 to 17.8 ng 100 ml À1 and from 0.23 to 0.35 ng ml À1 h À1 , respectively (both P ¼ 0.004) The proportion of patients with aldosterone 415 ng 100 ml À1 significantly increased from the follicular to the luteal phase, (8/26 vs 19/25, P ¼ 0.018); a similar increase was found for Aldosterone-PRA Ratio 430 combined with either a minimum PRA value of 0.5 ng ml À1 h À1 or aldosterone 415 ng 100 ml À1 (7/26 vs 16/25 and 7/26 vs 17/25 respectively, Po0.05).Aldosterone was positively related to PRA and progesterone. Higher aldosterone levels may be frequently encountered in the second part of the ovarian cycle in low-renin hypertensive women. This variability appears to be an important factor to be taken into account in the first-step laboratory screening for primary aldosteronism and should be considered in the process of standardization of the diagnostic work-up for this disease.

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Section: -13mentioning

confidence: 99%

Section: -13mentioning

confidence: 99%

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The ovarian cycle as a factor of variability in the laboratory screening for primary aldosteronism in women

et al. 2008

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“…1,2 However, guidelines for screening, confirmatory testing, and procedures to differentiate between unilateral and bilateral disease are rare, 3 and cutoff parameters are not prospectively evaluated. More than 98% of patients with PA present with unilateral aldosteroneproducing adenoma (APA) or bilateral idiopathic hyperaldosteronism (IHA).…”

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Adrenal Venous Sampling

et al. 2011

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Abstract-In patients with primary aldosteronism, adrenal venous sampling is helpful to distinguish between unilateral and bilateral adrenal diseases. However, the procedure is technically challenging, and selective bilateral catheterization often fails. The aim of this analysis was to evaluate success rate in a retrospective analysis and compare data with procedures done prospectively after introduction of measures designed to improve rates of successful cannulation. Patients were derived from a cross-sectional study involving 5 German centers (German Conn's registry Key Words: primary aldosteronism Ⅲ adrenal vein sampling Ⅲ aldosterone-producing adenoma Ⅲ bilateral idiopathic hyperaldosteronism Ⅲ rapid cortisol assay P rimary hyperaldosteronism (PA) is one of the common causes of secondary hypertension. 1,2 However, guidelines for screening, confirmatory testing, and procedures to differentiate between unilateral and bilateral disease are rare, 3 and cutoff parameters are not prospectively evaluated. More than 98% of patients with PA present with unilateral aldosteroneproducing adenoma (APA) or bilateral idiopathic hyperaldosteronism (IHA). In addition, there are monogenetic forms of PA. 4,5 However, therapy of the 2 subtypes APA and IHA differs substantially. Although hypertension attributed to unilateral APA can be cured surgically by adrenalectomy, IHA is treated by mineralocorticoid receptor antagonists.

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“…Patients with primary aldosteronism required substantially higher doses (up to 400 mg). 39 Current recommendations are to screen for primary aldosteronism in patients with an adrenal incidentaloma or unprovoked hypokalemia 40 and if blood pressure remains poorly controlled after adding spironolactone 100 mg daily. 39,40 It is important to recheck serum creatinine and electrolytes after 1 week on spironolactone and after each dose titration.…”

Section: Resistant Hypertensionmentioning

confidence: 99%

Update in New Medications for Primary Care

Smetana

Sillman

2008

J GEN INTERN MED

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E ach year, the FDA approves dozens of new drugs for use in clinical practice. Clinicians must wade through a staggering amount of evidence to determine which drugs will be important new additions to their practice. Many of the new drugs relate to specialty practices, such as chemotherapeutic agents and immune-based therapies. A fraction of the newly approved drugs are potentially relevant for primary care clinicians. Most of these drugs are "me too" drugs that are a new drug within an existing class of medications. For example, the FDA may approve a new beta-blocker or a new protonpump inhibitor. When these types of new drugs are as effective and safe as existing drugs, they are welcome primarily when their cost to patients and health plans is lower than that of currently available drugs.However, a small number of drugs each year are novel and relevant for primary care practice. These are drugs that work through a completely new mechanism compared to existing therapies and have the potential to represent an addition to our pharmacologic armamentarium. It is challenging for busy clinicians to determine which new drugs meet this requirement and to receive balanced information regarding efficacy, safety, side effects, and cost of these new medications. In addition, each year, new practice guidelines and systematic reviews provide guidance regarding optimal use and sequence of existing medications for common

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Is There an Unrecognized Epidemic of Primary Aldosteronism? (Pro)

Cited by 106 publications

References 38 publications

The ovarian cycle as a factor of variability in the laboratory screening for primary aldosteronism in women

The ovarian cycle as a factor of variability in the laboratory screening for primary aldosteronism in women

Adrenal Venous Sampling

Update in New Medications for Primary Care

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