Progress in Primary Aldosteronism 2019: New Players on the Block?

Abstract

Primary aldosteronism (PA) is characterized by hypertension caused by inappropriately high adrenal aldosterone secretion, consecutively low plasma renin, and an elevated aldosterone to renin ratio. It is nowadays the universally accepted main cause of endocrine hypertension. According to the most recent epidemiological data, PA is present in 5.8% of unselected hypertensives in primary care, 6–12% of hypertensives treated in hypertension centers, and up to 30% in subjects with resistant hypertension 1. Despite this high prevalence, a recent survey demonstrated that screening for PA is not universally followed. Renin and aldosterone measurements, the basis for PA screening, are currently performed by only 7% of general practitioners in Italy and 8% in Germany 2. Accordingly, the prevalence of PA was low with 1% among hypertensives in Italy and 2% in Germany. In a retrospective cohort study of 4660 patients with resistant hypertension in California the screening rate for PA was 2.1% 3. Based on these data, it is clear that we still miss the majority of PA cases, despite advances in diagnosis and therapy.

Evaluation of screening practices for primary hyperaldosteronism by specialists and general practitioners: an observational, cross-sectional study

“…According to the 2016 Endocrine Society guideline ( 9 ), PHA is a "major public health issue requiring immediate recognition and coordinated action". Indeed, studies show that the percentage of patients who undergo PHA screening among those who are eligible for screening is below 3% in the US ( 4 , 5 , 8 ) and below 8% in Italy and Germany ( 6 , 7 ). Therefore, for the proper design of strategies to increase PHA awareness, diagnosis, and treatment in our country, it is essential to evaluate the screening practices and understand the reasons why screening is not conducted when recommended.…”

“…Studies show that attending physicians fail to carry out screening tests even in situations in which PHA is highly prevalent, like resistant hypertension and spontaneous or diuretic-induced hypokalemia (4)(5)(6)(7)(8). This may be due to a lack of awareness of PHA prevalence and the importance of screening and diagnosing this condition for the implementation of adequate treatment, although other factors may also be involved.…”

Первичный Гиперальдостеронизм Как Причина Рефрактерной Артериальной Гипертензии. Клинический Случай

“…ст. при приеме 4 или более антигипертензивных препаратов;  артериальная гипертензия и гипокалиемия (в т. ч. индуцированная приемом диуретиков);  артериальная гипертензия с инциденталомой надпочечника;  артериальная гипертензия с синдромом обструктивного апноэ;  артериальная гипертензия и отягощенный семейный анамнез по наличию гипертензии или инсульта в молодом возрасте (до 40 лет);  артериальная гипертензия и наличие ПГА у родственников 1-й степени родства [9].…”

MANAGEMENT OF ENDOCRINE DISEASE: The role of surgical adrenalectomy in primary aldosteronism

“…Primary aldosteronism is common and largely unrecognized (1,2,3,4,5,6,7,8). It is likely that future studies will continue to demonstrate in greater detail the highly underestimated prevalence of primary aldosteronism.…”