Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

Yang, Yuhong; Reincke, Martín; Williams, Tracy Ann

doi:10.1016/j.beem.2019.101365

Cited by 34 publications

(34 citation statements)

References 136 publications

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“…Chronic inappropriate elevations in aldosterone can increase pro-inflammatory cytokines [4] and cause oxidative stress [5], which in the long-term leads to tissue damage and fibrosis [6]. As a result PA patients have higher cardiovascular risk than those with essential hypertension suggesting an impact of inappropriate aldosterone that is beyond increased blood pressure [7][8][9]. Moreover, the increased risk of morbidity at least with regard to cardiac remodeling may be reversible through targeted management with surgery or medical treatment that includes the use of mineralocorticoid receptor antagonist [8,10].…”

Section: Overview Of Primary Aldosteronism (Pa)mentioning

confidence: 99%

The Potential Role of Aldosterone-Producing Cell Clusters in Adrenal Disease

Lim

Rainey

2020

Horm Metab Res

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Primary aldosteronism (PA) is the most common cause of secondary hypertension. The hallmark of PA is adrenal production of aldosterone under suppressed renin conditions. PA subtypes include adrenal unilateral and bilateral hyperaldosteronism. Considerable progress has been made in defining the role for somatic gene mutations in aldosterone-producing adenomas (APA) as the primary cause of unilateral PA. This includes the use of next-generation sequencing (NGS) to define recurrent somatic mutations in APA that disrupt calcium signaling, increase aldosterone synthase (CYP11B2) expression, and aldosterone production. The use of CYP11B2 immunohistochemistry on adrenal glands from normal subjects, patients with unilateral and bilateral PA has allowed the identification of CYP11B2-positive cell foci, termed aldosterone-producing cell clusters (APCC). APCC lie beneath the adrenal capsule and like APA, many APCC harbor somatic gene mutations known to increase aldosterone production. These findings suggest that APCC may play a role in pathologic progression of PA. Herein, we provide an update on recent research directed at characterizing APCC and also discuss the unanswered questions related to the role of APCC in PA.

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Section: Overview Of Primary Aldosteronism (Pa)mentioning

confidence: 99%

The Potential Role of Aldosterone-Producing Cell Clusters in Adrenal Disease

Lim

Rainey

2020

Horm Metab Res

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“…The median age and BMI were 43 years (18-73) and 27 kg/m 2 (20-46), respectively. The median duration of HTN was 2.3 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Median preoperative systolic and diastolic BP was 150 mmHg (110-249) and 98 mmHg (70-151) on 3 (1-8) antihypertensives.…”

Section: Resultsmentioning

confidence: 99%

“…Primary aldosteronism (PA) is present in up to 33% of patients with secondary hypertension (HTN) [1]. It is characterized by renin-independent excess aldosterone which leads to drug-resistant hypertension and hypokalemia [2]. The source of aldosterone excess in PA may be from one adrenal gland as a result of an aldosterone-producing adenoma (APA) or unilateral hyperplasia.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Adrenalectomy and the Aldosteronoma Resolution Score in the Black and Hispanic Population

et al. 2021

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Background Outcomes after adrenalectomy in patients with primary aldosteronism (PA) are variable. The aldosteronoma resolution score (ARS) uses preoperative variables to calculate a score that identifies those patients that are more likely to have resolution of hypertension after adrenalectomy. We aim to determine the efficacy of adrenalectomy and whether the ARS accurately predicts clinical success in a Black and Hispanic population. Methods We reviewed patients who underwent adrenalectomy for PA from 2004 to 2018 at two academic centers treating primarily Hispanic and Black patients. Postoperative outcomes were evaluated based on the primary aldosteronism surgical outcome consensus criterion. Retrospectively, the accuracy of ARS was determined by a receiver operating characteristic curve and the area under the curve (AUC). Results Forty-three Hispanic and 10 Black patients underwent adrenalectomy for PA. Twenty-two patients (41.5%) had complete clinical success. Variables associated with complete clinical success in the univariate analysis were female gender (p = 0.026), younger age (p = 0.001), lower preoperative aldosterone (p = 0.035), lower preoperative systolic blood pressure (p = 0.001), fewer number of preoperative antihypertensive medications (p = 0.007) and a higher ARS (p = 0.003). On multivariate analysis, only fewer number of preoperative antihypertensive medications was independently associated with complete clinical success (p = 0.026). The AUC of the ARS was 0.746. Conclusion The rate of clinical success from adrenalectomy is good for Hispanic and Black patients with PA. Our analysis shows that the ARS is an accurate test of clinical success in Hispanic and Black patients. The ARS may be utilized preoperatively to frame expectations after adrenalectomy in these populations.

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“…Studies that evaluated the prevalence of PA based on hypertension grades showed a prevalence of 2.0% to 6.6% in grade I hypertension, 8.0% to 15.5% in grade II hypertension, and 11.8% to 19% in grade III hypertension. [22][23][24] Moreover, it increased to 20% in patients with resistant hypertension. 25 In the present study, the prevalence of PA was 3.31% in participants with general hypertension; however, as found in previous studies, the prevalence significantly increased with the hypertension grading (0.68%, 3.38%, and 12.64% among patients with grade I, II, and III hypertension, respectively).…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Subtype Classification, and Outcomes of Treatment of Primary Aldosteronism: A Prospective Study in China

Gao

Wang

et al. 2021

Endocrine Practice

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Objective: To investigate the prevalence of primary aldosteronism (PA) among participants with hypertension, evaluate the concordance of PA classification between adrenal computed tomography and adrenal venous sampling, and compare the outcomes of surgery and medication for unilateral PA. Methods: A prospective study was conducted among all inpatients with hypertension (n ¼ 7594) at the National Center for Cardiovascular Diseases, China, from May 2016 to April 2018. Results: Of the 7594 participants, 8.12% (n ¼ 617) with plasma aldosterone-renin ratio 3.7 were possible PA cases. Three hundred sixty-seven cases with plasma aldosterone-renin ratio 3.7 and plasma aldosterone concentration 10 ng/dL were confirmed using the recumbent saline infusion test (69.20%, 182 of 263) or the captopril challenge test (66.5%, 69 of 104, P > .05). The prevalence of PA was 3.31% (n ¼ 251). Of the 251 patients with PA, all of them had multiple comorbidities, and 49.40% (n ¼ 124) had spontaneous hypokalemia. The concordance of PA classification between adrenal computed tomography and adrenal venous sampling was only 47.11%. The patients' blood pressure declined to normal ranges in the adrenalectomy (85.71%, 30 of 35) and spironolactone (63.04%; 29 of 46) groups (P < .05). Furthermore, hypokalemia was normalized in the adrenalectomy (100.00%; 26 of 26) and spironolactone (94.74%; 18 of 19) groups. Conclusion: It is necessary to incorporate PA screening into routine practice for those with hypertension in the Chinese population. This will assist in ensuring that the best therapeutic schedule based on PA subtypes is devised. Additionally, as a result, it may contribute to restoring the blood pressure levels and reducing the prevalence of comorbidities in these patients with PA.

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Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

Cited by 34 publications

References 136 publications

The Potential Role of Aldosterone-Producing Cell Clusters in Adrenal Disease

The Potential Role of Aldosterone-Producing Cell Clusters in Adrenal Disease

Outcomes of Adrenalectomy and the Aldosteronoma Resolution Score in the Black and Hispanic Population

Prevalence, Subtype Classification, and Outcomes of Treatment of Primary Aldosteronism: A Prospective Study in China

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