Primary aldosteronism: A needle in a haystack or a yellow cab on fifth avenue?

Rossi, Gian Paolo

doi:10.1007/s11906-004-0001-0

Cited by 37 publications

(23 citation statements)

References 47 publications

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“…Primary aldosteronism (PA) is the most common form of secondary hypertension and affects up to 10% of all hypertensive patients (1,2,3,4,5). Patients with PA have an increased risk of developing relevant comortalities and comorbidities, e.g.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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Objective: Primary aldosteronism (PA) has deleterious effects on kidney function independent of blood pressure levels. Up to now, data on effectiveness of different PA therapies regarding renal function are scarce. Design and methods: This prospective multi-center study included 29 patients with newly diagnosed PA evaluated before and 1 year after treatment initiation, and a second cohort including 119 patients who were evaluated 5.3 and 6.8 years after treatment initiation. Glomerular filtration rate (GFR), spot urine albumin excretion/urinary creatinine (UAE/Ucrea) ratio, biochemical parameters, and 24-h blood pressure were measured. In a larger cross-sectional cohort, renal function was evaluated depending on the type of treatment (adrenalectomy (ADX; nZ86); spironolactone (nZ65); and eplerenone (nZ18)). Results: GFR and UAE/Ucrea ratio significantly decreased in newly diagnosed PA patients after treatment initiation. In the second cohort, GFR and UAE/Ucrea ratio did not change during study period, and blood pressure was well controlled. In the larger cross-sectional cohort, no differences were seen in GFR and UAE/Ucrea ratio between PA patients on different treatment regimens. However, eplerenone treatment showed lower potassium levels and higher number of required antihypertensive medications. Conclusions: Renal dysfunction with elevated albuminuria was seen in PA patients and was reversible after treatment initiation. Medical therapies with spironolactone or eplerenone seem to be as effective as ADX regarding renal function and blood pressure; however, sufficient daily doses need to be given.

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Section: Introductionmentioning

confidence: 99%

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Fourkiotis

Vonend²,

Diederich³

et al. 2013

European Journal of Endocrinology

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“…Primary aldosteronism has been increasingly recognized as a secondary form of hypertension with a far greater prevalence than previously suspected [1][2][3][4] and attention to aldosteronism is also increased because it bears a high cardiovascular and cerebrovascular risk. 5,6 A low-renin profile represents a hallmark of this condition but it is not clear to what extent it overlaps with the so-called 'low-renin (essential) hypertension' which is thought to affect about onethird of the hypertensive population and indicate a sodium volume-dependent hypertension deserving appropriate treatment.…”

Section: Introductionmentioning

confidence: 99%

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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“…Moreover, growing evidence 4 indicates that primary aldosteronism (PA) is a common cause of secondary hypertension: in the Primary Aldosteronism Prevalence in Italy (PAPY) study, a prospective survey of 1180 consecutive newly diagnosed hypertensive patients referred to specialized hypertension centers, aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) were found in 4.8% and 6.4% of all patients, respectively, thus leading to an overall prevalence of PA of Ϸ11%. 5 It has been contended that this form of secondary hypertension is relatively "benign," that is, devoid of cardiovascular complications, because of the suppression of the renin-angiotensin system, which plays a substantial role in cardiovascular remodeling and damage.…”

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confidence: 99%

Renal Damage in Primary Aldosteronism

et al. 2006

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Abstract-Primary aldosteronism (PA) has been associated with cardiovascular hypertrophy and fibrosis, in part independent of the blood pressure level, but deleterious effects on the kidneys are less clear. Likewise, it remains unknown if the kidney can be diversely involved in PA caused by aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA). Hence, in the Primary Aldosteronism Prevalence in Italy (PAPY) Study, a prospective survey of newly diagnosed consecutive patients referred to hypertension centers nationwide, we sought signs of renal damage in patients with PA and in comparable patients with primary hypertension (PH). Patients (nϭ1180) underwent a predefined screening protocol followed by tests for confirming PA and identifying the underlying adrenocortical pathology. Renal damage was assessed by 24-hour urine albumin excretion (UAE) rate and glomerular filtration rate (GFR). UAE rate was measured in 490 patients; all had a normal GFR. Of them, 31 (6.4%) had APA, 33 (6.7%) had IHA, and the rest (86.9%) had PH. UAE rate was predicted (PϽ0.001) by body mass index, age, urinary Na ϩ excretion, serum K ϩ , and mean blood pressure. Covariate-adjusted UAE rate was significantly higher in APA and IHA than in PH patients; there were more patients with microalbuminuria in the APA and IHA than in the PH group (Pϭ0.007). Among the hypertensive patients with a preserved GFR, those with APA or IHA have a higher UAE rate than comparable PH patients. Thus, hypertension because of excess autonomous aldosterone secretion features an early and more prominent renal damage than PH. Key Words: hypertension, endocrine Ⅲ aldosterone Ⅲ mineralocorticoids Ⅲ kidney Ⅲ hypertrophy Ⅲ adrenal gland T he results of large intervention trials 1,2 and cross-sectional studies (reviewed by Rossi et al 3 ) have recently refueled the interest on the deleterious cardiovascular effects of excess aldosterone. Moreover, growing evidence 4 indicates that primary aldosteronism (PA) is a common cause of secondary hypertension: in the Primary Aldosteronism Prevalence in Italy (PAPY) study, a prospective survey of 1180 consecutive newly diagnosed hypertensive patients referred to specialized hypertension centers, aldosterone-producing adenoma (APA) and idiopathic hyperaldosteronism (IHA) were found in 4.8% and 6.4% of all patients, respectively, thus leading to an overall prevalence of PA of Ϸ11%. 5 It has been contended that this form of secondary hypertension is relatively "benign," that is, devoid of cardiovascular complications, because of the suppression of the renin-angiotensin system, which plays a substantial role in cardiovascular remodeling and damage. 6,7 This view has, however, been challenged by recent data. 3,8 PA has in fact been associated with widespread tissue fibrosis, 9 vascular remodeling, 10 and excess prevalence of left ventricular hypertrophy and diastolic dysfunction 11 that were corrected by adrenalectomy. 12 A higher incidence of cardiovascular complications, including atrial fibrillation, has also been...

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Primary aldosteronism: A needle in a haystack or a yellow cab on fifth avenue?

Cited by 37 publications

References 47 publications

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism

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

Renal Damage in Primary Aldosteronism

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