Management of hypertension in primary aldosteronism

Abstract

Hypertension causes significant morbidity and mortality worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldosteronism (PA) is the most common cause of reversible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approximately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic resection, while bilateral hyperplasia is treated with mineralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemodynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medications in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, as manifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the importance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalectomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifactorial model convenient for use in daily clinical practice.

Numerical evaluation of microwave thermal ablation to treat small adrenocortical masses

“…One of the most common curable cause of secondary hypertension is Primary Aldosteronism (PA, also known as Conn's Syndrome) . PA is thought to account for up to 18% of all cases of hypertension within the hypertensive population . It is caused by benign, shallow, hormone‐eluding adenomas on the cortex of the adrenal gland.…”

Risk of ischemic stroke in primary aldosteronism patients

“…Treatment of PA is focused at prevention of morbidity following long duration of hypertension and aldosterone induced organ damage [40]. Spironolactone is aimed at antagonizing mineralocorticoid and helps improve "hypokalemia" in half PA patients.…”

The prevalence of primary aldosteronism (PA) in a group of 350 hypertensive patients

“…1%), family aldosteronism (about 1%) or unilateral nodular adrenal hyperplasia (approx. 1%) (the so-called 1% rule) [10]. Recently, in approximately 50% of patients with APA specific genetic alteration have been detected [9].…”