Prevalence of Adrenal and Extra-adrenal Conn Syndrome in Hypertensive Patients

Abdelhamid, S.; Müller-Lobeck, H; Pahl, Stefan; Remberger, K.; Bönhof, Joerg-A.; Walb, Dieter; Röckel, A

doi:10.1001/archinte.1996.00440100086010

Cited by 51 publications

(9 citation statements)

References 22 publications

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“…We did not include a study whose goal was to screen for PA among hypertensive patients with low PRA [23]. The seven eligible studies [1,2,10,[24][25][26][27] have been sorted by date of publication in Table 1. Using each authors' criteria, the prevalence of PA ranged from 4.6 to 14.4%, with an average of 6.6%.…”

Section: Primary Aldosteronism Subtypesmentioning

confidence: 99%

“…To estimate the proportion of APA among patients with PA, we selected papers reporting diagnostic tests for PA and at least 50 patients with definite PA. To avoid an indication bias, we excluded surgical series in which all patients had been operated on. Among the nine eligible reports sorted by publication date in Table 2 [5,7,25,[28][29][30][31][32][33], the proportions of APA among patients with PA ranged from 24.2 to 77.4%, with an average of 56.6%. Finally, to estimate the frequency of hypertension cure or improvement following surgery, we analyzed series from single centres reporting postoperative BP follow-up in at least 50 patients with PA [34][35][36][37][38][39].…”

Section: Primary Aldosteronism Subtypesmentioning

confidence: 99%

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Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension

Plouin¹,

Amar²,

Châtellier³

2004

Nephrology Dialysis Transplantation

109

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Section: Primary Aldosteronism Subtypesmentioning

confidence: 99%

Section: Primary Aldosteronism Subtypesmentioning

confidence: 99%

Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension

Plouin¹,

Amar²,

Châtellier³

2004

Nephrology Dialysis Transplantation

109

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“…Ectopic aldosterone‐secreting tumours (e.g. neoplasms in the ovary or kidney) are exceedingly rare 9 …”

Section: Introduction: ‘Painting Background’mentioning

confidence: 99%

Primary aldosteronism: renaissance of a syndrome

Young

2007

Clinical Endocrinology

585

486

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Great strides have been made in our understanding of the pathophysiology of primary aldosteronism syndrome since Conn's description of the clinical presentation of a patient with an aldosterone-producing adenoma (APA) more than 50 years ago. It is now recognized that the APA is just one of the seven subtypes of primary aldosteronism. APA and bilateral idiopathic hyperaldosteronism (IHA) are the most common subtypes of primary aldosteronism. Although most clinicians had thought primary aldosteronism to be a rare form of hypertension for more than three decades, it is now recognized to be the most common form of secondary hypertension. Using the plasma aldosterone to plasma renin activity ratio as a case-finding test, followed by aldosterone suppression confirmatory testing, has resulted in much higher prevalence estimates of 5-13% of all patients with hypertension. In addition, there has been a new recognition of the aldosterone-specific cardiovascular morbidity and mortality associated with aldosterone excess. Although thought to be daunting and complex in the past, the diagnostic approach to primary aldosteronism is straightforward and can be considered in three phases: case-finding tests, confirmatory tests and subtype evaluation tests. Patients with hypertension and hypokalaemia (regardless of presumed cause), treatment-resistant hypertension (three antihypertensive drugs and poor control), severe hypertension (>or= 160 mmHg systolic or >or= 100 mmHg diastolic), hypertension and an incidental adrenal mass, onset of hypertension at a young age or patients being evaluated for other forms of secondary hypertension should undergo screening for primary aldosteronism. In patients with suspected primary aldosteronism, screening can be accomplished by measuring a morning (preferably between 0800 and 1000 h) ambulatory paired random plasma aldosterone concentration (PAC) and plasma renin activity (PRA). An increased PAC:PRA ratio is not diagnostic by itself, and primary aldosteronism must be confirmed by demonstrating inappropriate aldosterone secretion. Aldosterone suppression testing can be performed with orally administered sodium chloride and measurement of urinary aldosterone or with intravenous sodium chloride loading and measurement of PAC. Unilateral adrenalectomy in patients with APA or unilateral adrenal hyperplasia results in normalization of hypokalaemia in all these patients; hypertension is improved in all and is cured in approximately 30-60% of them. In bilateral adrenal forms of primary aldosteronism, unilateral or bilateral adrenalectomy seldom corrects the hypertension and they should be treated medically with a mineralocorticoid receptor antagonist.

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“…1 But recent studies have suggested that primary hyperaldosteronism (PHA) may be present in at least 10% of patients. [2][3][4][5] These studies have used biochemical measures of autonomous aldosterone secretion, usually the ratio of plasma aldosterone to renin and the failure of aldosterone to suppress during treatment with salt supplementation. However, as often occurs when the arbiter for diagnosis changes -here, from anatomical to biochemical -the question arises whether the definition of the condition has also changed.…”

mentioning

confidence: 99%

Prevalence of primary hyperaldosteronism assessed by aldosterone/renin ratio and spironolactone testing

et al. 2005

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-Recent studies have suggested that primary hyperaldosteronism may be present in more than 10% of patients with hypertension. We aimed to estimate the prevalence in unselected patients in primary care, and investigate the influence of current drug treatment upon the aldosterone/renin ratio (ARR) and its prediction of blood pressure response to spironolactone. We measured blood pressure, plasma electrolytes, renin activity and aldosterone in 846 patients with hypertension. Spironolactone 50 mg was prescribed for one month to patients with blood pressure ≥130/85 mmHg and ARR ≥400. The primary outcome measure was to discover the proportion of patients with plasma aldosterone ≥400 pmol/l and ARR ≥800 and either an adrenal adenoma on computed tomography scan or a systolic blood pressure response to spironolactone ≥20 mmHg. Only one patient had an adenoma, and only 16 (1.8%) had both a plasma aldosterone ≥400 pmol/l and ARR ≥800. By contrast, 119 patients (14.1%) had an elevated ARR but normal plasma aldosterone. In 69 patients out of the 119 who received spironolactone, blood pressure fell by 26/11 mmHg. These patients were normokalaemic but had uncontrolled hypertension despite multiple drugs. The response to spironolactone was best predicted by a low plasma renin, ≤0.5 pmol/ml/h (<10 mU/l), despite treatment with an ACE inhibitor. We concluded that adrenal adenomas are an uncommon cause of hypertension. In the absence of hypokalaemia, a low plasma renin is a sufficient and simple way of detecting spironolactoneresponders among patients with resistant hypertension. Only patients with both hypokalaemia and low plasma renin, measured while the patient is off β blockade, require measurement of aldosterone. A plasma aldosterone >400 pmol/l together with renin activity ≤0.5 pmol/ml/h should trigger further investigations for an adrenal adenoma.

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Prevalence of Adrenal and Extra-adrenal Conn Syndrome in Hypertensive Patients

Abstract: Although E-APT is rare, it should be considered in the interests of specific therapy for PA because aldosterone-secreting malignant ovarian tumors also have been reported.

Cited by 51 publications

References 22 publications

Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension

Trends in the prevalence of primary aldosteronism, aldosterone-producing adenomas, and surgically correctable aldosterone-dependent hypertension

Primary aldosteronism: renaissance of a syndrome

Prevalence of primary hyperaldosteronism assessed by aldosterone/renin ratio and spironolactone testing

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