Prevalence of primary aldosteronism in primary care: a cross-sectional study

Käyser, Sabine; Deinum, Jaap; Grauw, Wim Jc De; Schalk, Bianca; Bor, Hans; Lenders, Jacques W.M.; Schermer, Tjard; Biermans, Marion C J

doi:10.3399/bjgp18x694589

Cited by 42 publications

(35 citation statements)

References 50 publications

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“…In contrast, according to a retrospective, international, multicenter study by Mulatero et al published in 2004, hypokalemic PA in fact accounts for only 9-37 % of cases [15]. This number is consistent with the results of numerous other studies [64][65][66][67][68]. ▶table 2 gives an overview of the relevant results of cited studies.…”

Section: Prevalence Of Hypokalemia In Pasupporting

confidence: 66%

Hypokalemia and the Prevalence of Primary Aldosteronism

Gruber

Beuschlein

2020

Horm Metab Res

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Hypokalemia is closely linked with the pathophysiology of primary aldosteronism (PA). Although hypokalemic PA is less common than the normokalemic course of the disease, hypokalemia is of particular importance for the manifestation and development of comorbidities. Specifically, a growing body of evidence demonstrates that hypokalemia in PA patients is associated with a more severe disease course regarding cardiovascular and metabolic morbidity and mortality. It is also well appreciated that low potassium levels per se can promote or exacerbate hypertension. The spectrum of hypokalemia-related symptoms ranges from asymptomatic courses to life-threatening conditions. Hypokalemia is found in 9–37% of all cases of PA with a predominance in patients with aldosterone producing adenoma. Conversely, hypokalemia resolves in almost 100% of cases after both, specific medical or surgical treatment of the disease. However, to date, high-level evidence about the prevalence of primary aldosteronism in a hypokalemic population is missing. Epidemiological data are expected from the recently launched IPAHK+study (“Incidence of Primary Aldosteronism in Patients with Hypokalemia”).

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Section: Prevalence Of Hypokalemia In Pasupporting

confidence: 66%

Hypokalemia and the Prevalence of Primary Aldosteronism

Gruber

Beuschlein

2020

Horm Metab Res

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“…Furthermore, the included subjects had only mild hypertension most likely due to diagnosis at earlier stages of the disease resulting from an increasing awareness for primary aldosteronism and broadened indications for screening. Therefore, the study population might not represent the historically described population with primary aldosteronism which presented most often with moderate to severe hypertension (30,31).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Primary Aldosteronism With mTORC1 Inhibitors

Trinh

Hepprich

Betz

et al. 2019

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Mammalian target of rapamycin complex 1 (mTORC1) activity is often increased in the adrenal cortex of patients with primary aldosteronism (PA), and mTORC1 inhibition decreases aldosterone production in adrenocortical cells, suggesting the mTORC1 pathway as a target for treatment of PA. Objective To investigate the effect of mTORC1 inhibition on adrenal steroid hormones and hemodynamic parameters in mice and in patients with PA. Design (i) Plasma aldosterone, corticosterone, and angiotensin II (Ang II) were measured in mice treated for 24 hours with vehicle or rapamycin. (ii) Plasma aldosterone levels after a saline infusion test, plasma renin, and 24-hour urine steroid hormone metabolome and hemodynamic parameters were measured during an open-label study in 12 patients with PA, before and after 2 weeks of treatment with everolimus and after a 2-week washout. Main Outcome Measures (i) Change in plasma aldosterone levels. (ii) Change in other steroid hormones, renin, Ang II, and hemodynamic parameters. Results Treatment of mice with rapamycin significantly decreased plasma aldosterone levels (P = 0.007). Overall, treatment of PA patients with everolimus significantly decreased blood pressure (P < 0.05) and increased renin levels (P = 0.001) but did not decrease aldosterone levels significantly. However, prominent reduction of aldosterone levels upon everolimus treatment was observed in four patients. Conclusion In mice, mTORC1 inhibition was associated with reduced plasma aldosterone levels. In patients with PA, mTORC1 inhibition was associated with improved blood pressure and renin suppression. In addition, mTORC1 inhibition appeared to reduce plasma aldosterone in a subset of patients.

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“…Primary aldosteronism (PA) is one of the most common causes of secondary hypertension. The estimated prevalence ranges from 3-6% in primary care [1,2] to 5-11% in referred hypertensive patients [3,4] and is even higher in patients with resistant hypertension (more than 11%) [5]. Diagnosing PA is important as targeted therapy may lower the increased risk for cardiovascular events and target organ damage [6] in these patients.…”

Section: Introductionmentioning

confidence: 99%

Development of a clinical decision tool to reduce diagnostic testing for primary aldosteronism in patients with difficult-to-control hypertension

et al. 2020

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Background: Satisfactory tools to preclude low-risk patients from intensive diagnostic testing for primary aldosteronism (PA) are lacking. Therefore, we aimed to develop a decision tool to determine which patients with difficult-to-control hypertension have a low probability of PA, thereby limiting the exposure to invasive testing while at the same time increasing the efficiency of testing in the remaining patients. Methods: Data from consecutive patients with difficult-to-control hypertension, analysed through a standardized diagnostic protocol between January 2010 and October 2017 (n = 824), were included in this cross-sectional study. PA was diagnosed by a combined approach: 1) elevated aldosterone-to-renin ratio (> 5.0 pmol/fmol/s), confirmed with 2) non-suppressible aldosterone after standardized saline infusion (≥280 pmol/L). Multivariable logistic regression analyses including seven pre-specified clinical variables (age, systolic blood pressure, serum potassium, potassium supplementation, serum sodium, eGFR and HbA1c) was performed. After correction for optimism, test reliability, discriminative performance and test characteristics were determined. Results: PA was diagnosed in 40 (4.9%) of 824 patients. Predicted probabilities of PA agreed well with observed frequencies and the c-statistic was 0.77 (95% confidence interval (95%CI) 0.70-0.83). Predicted probability cutoff values of 1.0-2.5% prevented unnecessary testing in 8-32% of the patients with difficult-to-control hypertension, carrying sensitivities of 0.98 (95%CI 0.96-0.99) and 0.92 (0.83-0.97), and negative predictive values of 0.99 (0.98-1.00) and 0.99 (0.97-0.99). Conclusions: With a decision tool, based on seven easy-to-measure clinical variables, patients with a low probability of PA can be reliably selected and a considerable proportion of patients with difficult-to-control hypertension can be spared intensive diagnostic testing.

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Prevalence of primary aldosteronism in primary care: a cross-sectional study

Cited by 42 publications

References 50 publications

Hypokalemia and the Prevalence of Primary Aldosteronism

Hypokalemia and the Prevalence of Primary Aldosteronism

Treatment of Primary Aldosteronism With mTORC1 Inhibitors

Development of a clinical decision tool to reduce diagnostic testing for primary aldosteronism in patients with difficult-to-control hypertension

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