Is Primary Aldosteronism Still Largely Unrecognized?

Abstract

Primary aldosteronism (PA) was first reported by Jerome W. Conn in 1954 when it was considered a rare disorder, only suspected in cases of hypertension and spontaneous hypokalemia. Over the last 30 years, with the wide application of the plasma aldosterone to plasma renin activity ratio as screening test, the clinical spectrum of PA has dramatically changed. Different studies displayed significant differences in term of patients investigated, diagnostic criteria and hormonal assays; however, large prospective studies with robust diagnostic criteria indicated that the prevalence of PA is around 6% of the general hypertensive population and 11% of the patients referred to hypertension centers. In light of these epidemiological studies, the Endocrine Society Guideline recommends the screening for PA of around 50% of patients with hypertension, and identifies the categories of patients at high risk for the disease. However, clinical data obtained from “real-life” show that the screening rate is much lower and PA remains an under-diagnosed and under-treated cause of secondary hypertension with an associated increased risk of cardio- and cerebrovascular mortality and morbidity.

Hormone and Metabolic Research: 50 Years of Research

“…Within the last couple of years, a special focus was given to endocrine tumors, e. g. of the neuroendocrine system including pituitary tumors and pheochromocytoma / paraganglioma. In addition, three issues were published on primary hyperaldosteronism focusing on the genetic cause of the disease as well as diagnostic and therapeutic options [2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Confirmatory tests for the diagnosis of primary aldosteronism: A systematic review and meta‐analysis

“…Primary aldosteronism (PA) is recognized as a common cause of secondary hypertension, possibly accounting for around 6% of the general hypertensive population and 11% of the tertiary care referral centres. 1 The accurate diagnosis of PA is of utmost importance as patients with PA experience worse cardiovascular and renal outcomes than those with blood pressure-matched essential hypertension (EH). [2][3][4][5] The diagnostic pathway of PA consists of three phases: screening, confirmation and subtype classification.…”

Primary Aldosteronism Complicated by Hypokalemic Rhabdomyolysis. A Clinical Case

“…Primary aldosteronism (PA) (Conn's syndrome) is a clinical syndrome caused by excess aldosterone production by zona glomerulosa of the adrenal cortex, which leads to low renin hypertension [1]. PA is the most common reason of high blood pressure among all secondary hypertensions and, according to various sources, occurs from 6% in the general population of patients with arterial hypertension to 20% among patients wth uncontrolled arterial hypertension [2][3][4][5]. Excess aldosterone leads to development of hypernatremia, hypokalemia and metabolic alkalosis.…”