A short review of primary aldosteronism in a question and answer fashion

Farrugia, Frederick‐Anthony; Zavras, Nick; Martikos, Georgios; Tzanetis, Panagiotis; Charalampopoulos, Anestis; Misiakos, Evangelos P.; Sotiropoulos, Dimitrios; Koliakos, Nikolaos

doi:10.2478/enr-2018-0005

Cited by 8 publications

(7 citation statements)

References 107 publications

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“…This condition is also called familial hyperaldosteronism type 1. In very young patients with PA, testing for germline mutations in KCNJ5 is recommended to diagnose familial hyperaldosteronism type 3 ( 41 ).…”

Section: Laboratory Investigation Of Hypokalemiamentioning

confidence: 99%

Hypokalemia: a clinical update

Kardalas

Paschou

Anagnostis

et al. 2018

Endocrine Connections

250

199

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Hypokalemia is a common electrolyte disturbance, especially in hospitalized patients. It can have various causes, including endocrine ones. Sometimes, hypokalemia requires urgent medical attention. The aim of this review is to present updated information regarding: (1) the definition and prevalence of hypokalemia, (2) the physiology of potassium homeostasis, (3) the various causes leading to hypokalemia, (4) the diagnostic steps for the assessment of hypokalemia and (5) the appropriate treatment of hypokalemia depending on the cause. Practical algorithms for the optimal diagnostic, treatment and follow-up strategy are presented, while an individualized approach is emphasized.

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Section: Laboratory Investigation Of Hypokalemiamentioning

confidence: 99%

Hypokalemia: a clinical update

Kardalas

Paschou

Anagnostis

et al. 2018

Endocrine Connections

250

199

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“…Therefore, serum potassium performed best if the cut-off to detect primary aldosteronism was set at <3.9 mmol/L which is above routine usage and guideline recommendations [ 16 , 17 ]. This may also be the cause to assume that the majority of patients affected by PA are normokalemic [ 18 , 19 , 20 ]. However, we could show that serum potassium along with SUSPPUP and renin normalizes during pharmacologic treatment and—even more and along with the ARR—after surgery, indicating that salt preservation on the expense of potassium is reversed with anti-mineralocorticoid treatment or removal of aldosterone-producing adenomas.…”

Section: Discussionmentioning

confidence: 99%

Aldosterone-Mediated Sodium Retention Is Reflected by the Serum Sodium to Urinary Sodium to (Serum Potassium)2 to Urinary Potassium (SUSPPUP) Index

et al. 2020

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The serum sodium to urinary sodium ratio divided by the (serum potassium)2 to urinary potassium ratio (SUSPPUP formula) reflects aldosterone action. We here prospectively investigated into the usefulness of the SUSPPUP ratio as a diagnostic tool in primary hyperaldosteronism. Parallel measurements of serum and urinary sodium and potassium concentrations (given in mmol/L) in the fasting state were done in 225 patients. Of them, 69 were diagnosed with primary aldosteronism (PA), 102 with essential hypertension (EH), 26 with adrenal insufficiency (AI) and 28 did not suffer from the above-mentioned disorders and were assigned to the reference group (REF). The result of the SUSPPUP formula was highest in the PA group (7.4, 4.2–12.3 L/mmol), followed by EH (3.2, 2.3–4.3 L/mmol), PA after surgery (3.9, 3.0–6.0 L/mmol), REF (3.4 ± 1.4 L/mmol) and AI (2.9 +/− 1.2 L/mmol). The best sensitivity in distinguishing PA from EH was reached by multiplication of the aldosterone to renin-ratio (ARR) with the SUSPPUP formula (92.7% at a cut off > 110 L/mmol), highest specificity was reached by the SUSPPUP determinations (87.2%). The integration of the SUSPPUP ratio into the ARR helps to improve the diagnosis of hyperaldosteronism substantially.

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“…PA is the most common and curable cause of secondary hypertension [1]. PA was initially described by Lity ński in Poland in 1953, then 2 years later in 1955 by Conn in the USA [2]. PA is associated with excessive and autonomous production of aldosterone.…”

Section: Introductionmentioning

confidence: 99%

“…Hypokalaemia had originally been considered a principal feature of PA; however, recent studies have reported that hypokalaemia is present only in 28% of PA patients. The most common causes of PA are bilateral idiopathic hypertrophy (BIH) (60% of cases) and aldosterone-producing adenomas (APAs; called Conn's Syndrome) (35% of cases, although these percentages are changing over time) [2]. The rare causes of PA are unilateral hyperplasia, familial hyperaldosteronism (types I-IV), aldosterone-producing carcinoma, and ectopic aldosterone production [1].…”

Section: Introductionmentioning

confidence: 99%

What We Know about and What Is New in Primary Aldosteronism

Ekman,

Grossman,

Dworakowska

2024

IJMS

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Primary aldosteronism (PA), a significant and curable cause of secondary hypertension, is seen in 5–10% of hypertensive patients, with its prevalence contingent upon the severity of the hypertension. The principal aetiologies of PA include bilateral idiopathic hypertrophy (BIH) and aldosterone-producing adenomas (APAs), while the less frequent causes include unilateral hyperplasia, familial hyperaldosteronism (FH) types I-IV, aldosterone-producing carcinoma, and ectopic aldosterone synthesis. This condition, characterised by excessive aldosterone secretion, leads to augmented sodium and water reabsorption alongside potassium loss, culminating in distinct clinical hallmarks: elevated aldosterone levels, suppressed renin levels, and hypertension. Notably, hypokalaemia is present in only 28% of patients with PA and is not a primary indicator. The association of PA with an escalated cardiovascular risk profile, independent of blood pressure levels, is notable. Patients with PA exhibit a heightened incidence of cardiovascular events compared to counterparts with essential hypertension, matched for age, sex, and blood pressure levels. Despite its prevalence, PA remains frequently undiagnosed, underscoring the imperative for enhanced screening protocols. The diagnostic process for PA entails a tripartite assessment: the aldosterone/renin ratio (ARR) as the initial screening tool, followed by confirmatory and subtyping tests. A positive ARR necessitates confirmatory testing to rule out false positives. Subtyping, achieved through computed tomography and adrenal vein sampling, aims to distinguish between unilateral and bilateral PA forms, guiding targeted therapeutic strategies. New radionuclide imaging may facilitate and accelerate such subtyping and localisation. For unilateral adrenal adenoma or hyperplasia, surgical intervention is optimal, whereas bilateral idiopathic hyperplasia warrants treatment with mineralocorticoid antagonists (MRAs). This review amalgamates established and emerging insights into the management of primary aldosteronism.

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A short review of primary aldosteronism in a question and answer fashion

Cited by 8 publications

References 107 publications

Hypokalemia: a clinical update

Hypokalemia: a clinical update

Aldosterone-Mediated Sodium Retention Is Reflected by the Serum Sodium to Urinary Sodium to (Serum Potassium)2 to Urinary Potassium (SUSPPUP) Index

What We Know about and What Is New in Primary Aldosteronism

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