Primary Aldosteronism: Diagnostic Accuracy of the Losartan and Captopril Tests

Wu, Vin‐Cent; Chang, Hung-Wei; Liu, Kao–Lang; Lin, Yen‐Hung; Chueh, Shih-Chieh; Lin, Wei-Chou; Ho, Yen Teng; Huang, Jeng-Wen; Chiang, Chih‐Kang; Yang, Shan-Yi; Chen, Ming-Fong; Wang, Shuo-Meng; Huang, Kuo‐How; Hsieh, Bor‐Shen; Wu, Kwan‐Dun

doi:10.1038/ajh.2009.89

Cited by 78 publications

(87 citation statements)

References 25 publications

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“…Other authors suggest that a post-losartan ARR > 60 with a PAC > 10 ng/dL could be more accurate than the captopril test for the diagnosis of PA and for adequately differentiating APA from IHA [39].…”

Section: Discussionmentioning

confidence: 99%

“…2) non-lateralization of aldosterone secretion at AVS or dexamethasone suppression adrenocortical scintigraphy; 3) evidence of bilateral diffuse enlargement on CT scan, and/or 4) postsaline loading (PAC > 10 ng/dl) and/or evidence of diffuse hyperplasia of cells on pathologic findings [39].…”

Section: Discussionmentioning

confidence: 99%

“…APA and HIA (or BAH), can be diagnosed on the basis of four modified "corners score criteria" [16,39]. More exactly, APA can be established when all of the following criteria are met: 1) evidence of autonomous excess aldosterone production based on an ARR > 30; 2) lateralization of aldosterone secretion at AVS or during dexamethasone suppression adrenocortical scintigraphy; 3) evidence of a nodule on CT scan; and 4) postsaline loading (PAC > 10 ng/dl) and/or a pathologically proved adenoma after adrenalectomy and cure of hypertension without antihypertensive agents or improved hypertension, potassium, PAC, and PRA.…”

Section: Discussionmentioning

confidence: 99%

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Increasing Incidence of Primary Aldosteronism in Patients Investigated for Resistant Hypertension: An Observational Study from a Nephrology Unit

Giudice¹

2012

J Nephrol Therapeutic

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Introduction: Primary Aldosteronism (PA) is a secondary form of hypertension characterized by an autonomous and inappropriately high production of aldosterone. Its prevalence is 5-12% and the two main subtypes are the Bilateral Adrenal Hyperplasia (BAH) and the Aldosterone-Producing Adenoma (APA). In this study, we report the results of an evalutation of some patients diagnosed with PA in a Nephrology Unit between 1987-2011.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Increasing Incidence of Primary Aldosteronism in Patients Investigated for Resistant Hypertension: An Observational Study from a Nephrology Unit

Giudice¹

2012

J Nephrol Therapeutic

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“…Other tests, such as the furosemide upright posture [ 99 ] and the losartan test [ 100,101 ] , are used in some units, but at present they are not recommended by the Guidelines due to insuf fi cient use and evidence.…”

Section: Con Fi Rmatory Testsmentioning

confidence: 98%

Primary Aldosteronism: Progress in Diagnosis, Therapy, and Genetics

Mulatero

Williams

Monticone

et al. 2012

Endocrine Hypertension

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Primary aldosteronism (PA) is the most frequent cause of secondary hypertension and its prevalence increases with the severity of hypertension. The importance of PA diagnosis is not just related to offering a targeted treatment, that is, adrenalectomy, for aldosterone-producing adenoma and medical therapy with mineralocorticoid receptor antagonists for bilateral adrenal hyperplasia, but also because it has been demonstrated extensively that patients affected by PA are more susceptible to cardiovascular events and target organ damage compared to essential hypertensives. Herein, we review the pathophysiology of PA and its clinical features and potential complications; the three step approach employed in the diagnosis of PA, established by the Endocrine Society Guidelines, that is, screening, con fi rmation/exclusion, and subtype diagnosis are discussed; the rarer, familial, and sporadic genetic forms of PA are explained and we conclude with a section on targeted PA therapy.

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“…The present study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database and tissue bank [16][17][18] . The database was constructed from June 2008 to March 2011 for quality assurance at 2 medical centers and their 3 affiliated hospitals and two local hospitals in different cities in Taiwan 19 .…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Clinical Correlates of Somatic Mutation in Aldosterone Producing Adenoma-Taiwanese population

Huang

et al. 2015

Journal of Hypertension

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Primary aldosteronism (PA) is a common form of secondary hypertension and has significant cardiovascular consequences. Mutated channelopathy due to the activation of calcium channels has been recently described in aldosterone-producing adenoma (APA). The study involved 148 consecutive PA patients, (66 males; aged 56.3 ± 12.3years) who received adrenalectomy, and were collected from the Taiwan PA investigator (TAIPAI) group. A high rate of somatic mutation in APA was found (n = 91, 61.5%); including mutations in KCNJ5 (n = 88, 59.5%), ATP1A1 (n = 2, 1.4%), and ATP2B3 (n = 1, 0.7%); however, no mutations in CACNA1D were identified. Mutation-carriers were younger (<0.001), had lower Cyst C (p = 0.042), pulse wave velocity (p = 0.027), C-reactive protein (p = 0.042) and a lower rate of proteinuria (p = 0.031) than non-carriers. After multivariate adjustment, mutation carriers had lower serum CRP levels than non-carriers (p = 0.031. Patients with mutation also had a greater chance of recovery from hypertension after operation (p = 0.005). A high incidence of somatic mutations in APA was identified in the Taiwanese population. Mutationcarriers had lower CRP levels and a higher rate of cure of hypertension after adrenalectomy. This raises the possibility of using mutation screening as a tool in predicting long-term outcome after adrenalectomy.Primary aldosteronism (PA), characterized by the autonomous production of aldosterone, is a common potentially curable cause of secondary hypertension 1 . It affects 5-13% of patients with hypertension in specialized centers 2,3 . PA patients have a high incidence of cardiovascular events in comparison with essential hypertension (EH) patients 4,5 . Somatic mutations in the selectivity filter of the KCNJ5 channel in APA result in a loss of selectivity for potassium and the entry of sodium, resulting in membrane depolarization, calcium mobilization, increased CYP11B2 expression, and aldosteronism 6 . Further exome sequencing of aldosterone producing adenoma (APA) has identified ATPase mutations in ATP1A1 and ATP2B3, which could lead to the opening of voltage-dependent calcium (Ca 2+ ) channels 7,8 . The CACNA1D mutation induced a shift in voltage-dependent gating to a more negative voltage, again implicating gain-of-function Ca 2+ channel mutations in APAs 9,10 . Therefore, aldosterone secretion is regulated

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Primary Aldosteronism: Diagnostic Accuracy of the Losartan and Captopril Tests

Abstract: The postlosartan ARR and PAC were shown to have better accuracy for the diagnosis of PA than the captopril test. With a postlosartan ARR >60, APAs can be adequately differentiated from IHA.

Cited by 78 publications

References 25 publications

Increasing Incidence of Primary Aldosteronism in Patients Investigated for Resistant Hypertension: An Observational Study from a Nephrology Unit

Increasing Incidence of Primary Aldosteronism in Patients Investigated for Resistant Hypertension: An Observational Study from a Nephrology Unit

Primary Aldosteronism: Progress in Diagnosis, Therapy, and Genetics

Prevalence and Clinical Correlates of Somatic Mutation in Aldosterone Producing Adenoma-Taiwanese population

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