Should primary aldosteronism be diagnosed among normotensive subjects during general health check-up and/or at general outpatient clinics?

Nishikawa, Tetsuo; Omura, Masao

doi:10.1038/hr.2010.202

Cited by 6 publications

(4 citation statements)

References 31 publications

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“…Yet, our patients had a stable metabolic and ponderal status during follow‐up, rendering metabolic factors unlikely as explanation for remission. Furthermore, several case reports describe examples of ‘normotensive PA‐patients’ with hypokalaemia or white coat hypertension with no left ventricular hypertrophy and consistently raised ARR while taking no medications, positive aldosterone suppression tests and sometimes even adrenal nodules on imaging, with women being over‐represented 26–29 . Also, reduced renal glomerular function by factors like age, hypertension and aldosterone excess might affect the interpretability of measurements of aldosterone or its metabolites in the urine 30 .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous remission of idiopathic aldosteronism after long‐term treatment with spironolactone: results from the German Conn’s Registry

Fischer

Beuschlein

Degenhart³

et al. 2012

Clinical Endocrinology

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SummaryContext Primary aldosteronism (PA) is mainly caused by aldosterone-producing adenoma and idiopathic bilateral adrenal hyperplasia (IHA). Recently, spontaneous resolution of IHA has been described. Objective We aimed to determine the frequency of spontaneous remission of PA during long-term treatment with mineralocorticoid receptor (MR) antagonists. Design, setting and patients Thirty-seven patients of the Munich PA registry with IHA treated by MR antagonists were investigated. The patients were identified retrospectively by chart review and prospectively assessed by clinical and biochemical means. Main outcome measures Complete remission of IHA was defined as normal aldosterone to renin ratio (ARR), normal suppression test and normalization of hypokalaemia in the presence of normal blood pressure. Partial remission was defined as normalization of normal ARR, normal suppression test and normalization of hypokalaemia in the presence of persistent hypertension. Results The mean period of MR antagonist treatment was 5AE8 ± 0AE7 years in the patients. We identified two of 37 (5AE4%) patients with spontaneous remission: one with complete remission and one with partial remission. Conclusion Remission of IHA in PA may occur in some patients after long-term mineralocorticoid antagonist treatment.

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Section: Discussionmentioning

confidence: 99%

Spontaneous remission of idiopathic aldosteronism after long‐term treatment with spironolactone: results from the German Conn’s Registry

Fischer

Beuschlein

Degenhart³

et al. 2012

Clinical Endocrinology

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“…Concerning screening, broader indications have been proposed on top of current: patients with unexplained atrial fibrillation (AF), unexplained hypokalemia regardless of blood pressure (BP), HTmediated organ damage excessive of BP values, HT at a young age, as well as patients with low-renin HT, all newly diagnosed HT patients and even prehypertensive individuals (i. e. with systolic BP, SBP, of 120 to 139 and/or diastolic BP, DBP, of 80 to 89 mm Hg) [5,[10][11][12][13][14]. Last year, Brown et al reported a 9 % crude prevalence of biochemically-overt PA (in OSLT) in 289 normotensives recruited at three academic centers [15].…”

Section: Controversies Concerning Conventional Approach Toward Primary Aldosteronismmentioning

confidence: 99%

Autonomous Aldosterone Secretion as a Subclinical Form of Primary Aldosteronism: Pathogenesis and Clinical Significance

Kmieć

Sworczak

2021

Exp Clin Endocrinol Diabetes

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In recent years, a substantial prevalence of primary aldosteronism (PA) has been demonstrated in both normotensive and mildly hypertensive cohorts. Consequently, a classic presentation of the syndrome, i. e. moderate-to-severe and resistant hypertension with concomitant hypokalemia, should be considered a tip-of-the-iceberg phenotype of a wide PA spectrum. Its entire range encompasses the non-classic clinical forms of mild hypertension and prehypertension but also several biochemical presentations, including patients who meet PA screening and confirmation test criteria, as well as those with either of them and those with other parameters indicating mineralocorticoid excess. In the current review, research insights on the pathogenetic background and clinical significance of autonomous aldosterone secretion (AAS) are presented, which is defined as a constellation of either: 1) normotension, normokalemia, a positive PA screening (high aldosterone-to-renin ratio) and/or confirmation test, or 2) hypertension, normokalemia and a positive PA screening but negative confirmation test. For this purpose, a literature search of the PubMed database was conducted. Advances in immunohistochemistry and genetic sequencing of isolated adrenal cells are provided as probable morphologic basis of the wide range of aldosterone secretion autonomy. Also, the role of corticotropin as an aldosterone secretagogue is discussed. To date, clinical studies depict consequences of subclinical PA phenotypes, such as increased mortality and risk of developing hypertension, impaired arterial and kidney function, association with metabolic syndrome and age, as well as osteoporosis.

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“… 6 Ito et al 7 found that the prevalence of PA was at least 6.8%, 3.3%, and 3.1% in patients with prehypertension, Stage 1 hypertension, and Stage 2 hypertension, respectively. 8 Therefore, it would appear that PA is not confined to hypertensive patients, but can be a common diagnosis among patients without hypertension. 9 More than half of the patients with normotensive PA are female, in the age group of 23–84 years.…”

Section: Discussionmentioning

confidence: 99%

Normotensive presentation in primary aldosteronism: A report of two cases

Jia

Liu

et al. 2021

J Renin Angiotensin Aldosterone Syst

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Normotensive patients with primary aldosteronism (PA) are relatively rare. Herein, we report two patients with normotensive PA and present a literature review to improve an understanding of the disease. Patient 1, a 56-year-old man, presented with recurrent hypokalemia that lasted for more than 2 years. Patient 2 was a 33-year-old man who presented with sexual dysfunction and was diagnosed with a prolactinoma combined with adrenal insufficiency and hypogonadism. Neither of these patients had hypertension that was detectable on repeated manual measurements. In both patients, a typical biological profile of PA was demonstrated that included hypokalemia with kaliuresis, elevated plasma aldosterone concentration (PAC), suppressed plasma renin concentration, and a high aldosterone-to-renin ratio. Both patients did not have sufficiently suppressed PAC on the saline infusion test, confirming the diagnosis of PA. Computed tomography of the adrenal gland and adrenal venous sampling suggested an aldosteronoma, which was confirmed by lateralized hypersecretion of aldosterone. After removal of the benign adenoma, the biochemical abnormalities were corrected. As hypertension is not necessarily a sign of PA, we propose that all patients with hypokalemia should be screened for PA in order to prevent cardiovascular complications while balancing economics and effectiveness.

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Should primary aldosteronism be diagnosed among normotensive subjects during general health check-up and/or at general outpatient clinics?

Cited by 6 publications

References 31 publications

Spontaneous remission of idiopathic aldosteronism after long‐term treatment with spironolactone: results from the German Conn’s Registry

Spontaneous remission of idiopathic aldosteronism after long‐term treatment with spironolactone: results from the German Conn’s Registry

Autonomous Aldosterone Secretion as a Subclinical Form of Primary Aldosteronism: Pathogenesis and Clinical Significance

Normotensive presentation in primary aldosteronism: A report of two cases

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