Primary aldosteronism: key characteristics at diagnosis: a trend toward milder forms

Heinrich, Daniel A.; Adolf, Christian; Rump, Lars Christian; Quack, Ivo; Quinkler, Marcus; Hahner, Stefanie; Januszewicz, Andrzej; Seufert, Jochen; Willenberg, Holger S.; Nirschl, Nina; Sturm, Lisa; Beuschlein, Felix; Reincke, Martín

doi:10.1530/eje-17-0978

Cited by 35 publications

(26 citation statements)

References 29 publications

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“…Anyway, the current indications for screening are still quite reasonable and provide for a great number of idiopathic adrenal hyperplasia (IAH) to be diagnosed; this also identified IAH as the most common cause of PA (2). In recent years, a trend of diagnosing milder forms of PA due to IAH has been observed, as is confirmed in the largest and most recent study (4). Clinical picture of aldosterone-producing adenoma (APA) is more specific due to the signs of the frequently present hypokalaemia (5).…”

Section: Introductionmentioning

confidence: 86%

Biochemical and clinical characteristics of patients with primary aldosteronism – single centre experience

Vujačić

Paunović²,

Diklić³

et al. 2019

Journal of Medical Biochemistry

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Summary Background Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications. Methods Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS). Results Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p<0.001). The metabolic syndrome was significantly less common in the PA group (37.5% vs. 70% in CS+SCS and 65% in NFA+HT group; p=0.015), although there was no significant difference in any of the analysed metabolic parameters between groups. PA group was found to have the most patients with glucose intolerance (81.8%), although the difference was not significant. The mean BMI for all three groups was in the overweight range. Patients with PA had higher microalbuminuria and a higher tendency for cardiovascular, renal and cerebrovascular events, but the difference was not significant. Conclusions Our results support the importance of the early recognition of primary aldosteronism on the bases of clinical presentation, as well as an increased screening intensity.

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Section: Introductionmentioning

confidence: 86%

Biochemical and clinical characteristics of patients with primary aldosteronism – single centre experience

Vujačić

Paunović²,

Diklić³

et al. 2019

Journal of Medical Biochemistry

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“…Recently, Heinrich et al confessed to performing initial screening for ARR with the patients receiving their usual medications which seems a very sensible option (46). The withdrawal of medications in high risk patients was scheduled as follows: betablockers, ACE inhibitors, angiotensin II receptor blockers, calcium blockers and low-dose thiazydes were terminated at least one week prior to testing, while loop diuretics and MR antagonists -at least 4 weeks prior to testing (46,47). These rules are slightly different from current ES recommendations where longer periods of withdrawal are recommended for most antihypertensives (10).…”

Section: Diagnostic Work-up For Primary Aldosteronism -Withdraw or Domentioning

confidence: 99%

Primary aldosteronism – the expanding spectrum of unsolved practical issues

Łebek-Szatańska

Papierska²

2020

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Primary aldosteronism is the most frequent cause of hormonal hypertension. Recent findings support the concept of continuous spectrum of autonomous aldosterone secretion with mild or subclinical forms being even more common than was suspected. Assumptions emerge that a considerable number of low-renin hypertensives might actually have aldosterone overproduction. However, the awareness of the disease and its consequences is still unsatisfactory. Nowadays experts are still trying to manage some unanswered questions and on-going debate on who should be screened for primary aldosteronism and how to do so.

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“…The higher prevalence in more recent studies is based on the use of the aldosterone-to-renin-ratio (ARR). The ARR allows detecting the normokalemic subtype of PA, which is much more frequent and also considered as a milder form of PA [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, to the best of our knowledge, data on atherosclerotic burden in patients with PA are still missing. Nowadays, based on increased screening intensity for PA using the ARR, more and more milder cases of PA are diagnosed [4]. In this context it has been speculated that atherosclerosis and cardiovascular risk could depend on PA phenotype and be consequently lower in patients with milder forms of PA [18].…”

Section: Introductionmentioning

confidence: 99%

Atherosclerotic Burden and Arterial Stiffness are Not Increased in Patients with Milder Forms of Primary Aldosteronism Compared to Patients with Essential Hypertension

et al. 2021

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Patients with primary aldosteronism (PA) are at increased cardiovascular risk, compared to patients with essential hypertension (EH). Cardiovascular damage could depend on PA phenotype, potentially being lower in milder forms of PA. Our aim was to assess atherosclerotic burden and arterial stiffness in 88 prospectively recruited patients, including 44 patients with mild PA and EH respectively. All patients underwent a structured study program, including measurements of ankle-brachial index, oscillometric measurement of central pulse wave velocity (cPWV) and vascular ultrasound examination of the supraaortic arteries, the abdominal aorta, and the femoropopliteal arteries. A plaque score was calculated to estimate atherosclerotic burden for each patient. This is a prospective case-control study set at a tertiary care hospital. Patients with PA and EH matched well for age, gender, blood pressure, BMI, and cardiovascular risk factors such as diabetes mellitus and smoking status. Common carotid intima-media thickness (0.77 vs. 0.75 mm; p=0.997) and cPWV (7.2 vs. 7.1 m/s; p=0.372) were comparable between patients with PA and EH. The atherosclerotic burden, as expressed by the plaque score, did not differ between the two groups (p=0.159). However, after initiation of treatment cPWV was significantly decreased in patients with PA (p=0.017). This study shows that subclinical atherosclerotic burden and arterial stiffness in patients with milder forms of PA is comparable to patients with EH. Nevertheless, specific treatment for PA significantly improved cPWV, which argues for a more liberal use of mineralocorticoid receptor antagonists in patients with arterial hypertension.

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Primary aldosteronism: key characteristics at diagnosis: a trend toward milder forms

Abstract: Our results are in accordance with an increased screening intensity for PA. We identified a trend toward diagnosing milder forms, increasingly more females and less unilateral cases of PA.

Cited by 35 publications

References 29 publications

Biochemical and clinical characteristics of patients with primary aldosteronism – single centre experience

Biochemical and clinical characteristics of patients with primary aldosteronism – single centre experience

Primary aldosteronism – the expanding spectrum of unsolved practical issues

Atherosclerotic Burden and Arterial Stiffness are Not Increased in Patients with Milder Forms of Primary Aldosteronism Compared to Patients with Essential Hypertension

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