Review: Diagnosis and management of primary aldosteronism

Stowasser, Michael; Gordon, Richard D.; Rutherford, John C.; Nikwan, Nik; Daunt, Nicholas; Slater, Gregory

doi:10.3317/jraas.2001.022

Cited by 155 publications

(158 citation statements)

References 103 publications

(162 reference statements)

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“…Medications that might interfere with the renin-ALD axis, such as steroids, sex hormones, liquorice or non-steroidal anti-inflammatory drugs were also withheld for at least 3 weeks. Subjects with hypokalemia, which can cause false-negative ratios (29), were given adequate oral KCl supplements before the study. Since we wanted to examine a population of unselected patients that was as representative as possible of the general population dealt with in the clinical practice, all subjects were asked to follow their usual diet, without any attempt to control sodium intake or modify lifestyle.…”

Section: Methodsmentioning

confidence: 99%

“…ALD antagonists were discontinued at least 6 weeks before the investigation; angiotensin converting enzyme (ACE) inhibitors and Ang II receptor blockers were discontinued 4 weeks before; β-blockers, dihydropyridine-type calcium antagonists and clonidine were progressively reduced and withdrawn 2 weeks before. α1-Blockers and slow-release forms of verapamil, which have a lesser effect on the ARR (29,30) were withdrawn 1 week before. Medications that might interfere with the renin-ALD axis, such as steroids, sex hormones, liquorice or non-steroidal anti-inflammatory drugs were also withheld for at least 3 weeks.…”

Section: Methodsmentioning

confidence: 99%

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Prevalence of Primary Aldosteronism among Unselected Hypertensive Patients: A Prospective Study Based on the Use of an Aldosterone/Renin Ratio above 25 as a Screening Test

et al. 2007

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prevalence of Primary Aldosteronism among Unselected Hypertensive Patients: A Prospective Study Based on the Use of an Aldosterone/Renin Ratio above 25 as a Screening Test

et al. 2007

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“…Stowasser et al found that more than 50 % of aldosteroneproducing adenomas were less than 1 cm in size [22]. A CT of the adrenal glands is nevertheless useful, as it can rule out adrenal cortex carcinoma while displaying the anatomy of the adrenal veins.…”

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confidence: 99%

Indication and Technical Aspects of Adrenal Blood Sampling

Blondin

Quack

Kücükköylü

et al. 2014

Fortschr Röntgenstr

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Adrenal disorders are relative frequent with regard to the incidence of adrenal tumors and the high portion in causes of secondary hypertension. Morphological changes in the adrenal glands can lead to very different functional disorders that may be clinically overt or hard to diagnose. On the other hand, they can already be functionally relevant when structural changes are too small to be picked up by imaging. Adrenal venous sampling serves to determine the source of hormone excess through the analysis of adrenal blood. In this manuscript, we call attention to the clinical backgrounds, critical points in praxis, technical aspects and developments in the the field of adrenal venous sampling. The consideration of these important points in the clincal setting may make adrenal vein sampling studies sucessful and help to select patients that qualify for adrenalectomy. Key Points: ??Selective adrenal venous sampling (AVS) currently continues to be the gold standard for localization diagnostics in patients with primary hyperaldosteronism. ??Comprehensive standardization of all preceding examinations and AVS is necessary to ensure high success rates. ??The method is supported by contrast-enhanced imaging for ensuring proper positioning of the catheter in the adrenal veins and the rapid cortisol assay. ??Knowledge of the anatomy and normal variants of the adrenal veins facilitates adrenal venous sampling. Citation Format: ??Blondin D, Quack I, Haase M et?al. Indication and Technical Aspects of Adrenal Blood Sampling. Fortschr R?ntgenstr 2015; 187: 19???28

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“…Being a potentially curable disease, correct diagnosis is crucial for specific treatment, such as mineralocorticoid antagonist therapy and adrenalectomy (3). Only 10-30% of patients present with the classical symptoms characterized by hypertension and hypokalaemia, whereas the large majority presents with normal serum potassium, thus showing a milder variant of this disorder (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…Primary aldosteronism has recently been recognized as the most frequent cause of secondary hypertension, occurring with a prevalence of 5-18% within the hypertensive population (1)(2)(3)(4). Being a potentially curable disease, correct diagnosis is crucial for specific treatment, such as mineralocorticoid antagonist therapy and adrenalectomy (3).…”

Section: Introductionmentioning

confidence: 99%

Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

Schirpenbach¹,

Seiler²,

Maser-Gluth³

et al. 2006

eur j endocrinol

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Objective: Primary aldosteronism has recently been recognized as the most frequent cause of secondary hypertension. Since most patients are normokalaemic, differentiation to essential hypertension is challenging. As differentiation by baseline aldosterone/renin ratio may be insufficient, diagnosis should be confirmed by additional tests. However, as most confirmatory tests have been evaluated in hypokalaemic primary aldosteronism only, we reassessed the value of the saline infusion test and 24 h urinary aldosterone metabolites as confirmatory tests for both normo-and hypokalaemic primary aldosteronism under current antihypertensive medication. Patients and methods: 25 patients with primary aldosteronism (11 hypokalaemic, 14 normokalaemic), 29 patients with essential hypertension and 47 normotensive subjects were studied. The hypertensives received their usual medication with the exception of spironolactone. All subjects underwent a standard saline infusion test (determination of plasma aldosterone before and after 2.0 liters of isotonic saline for 4 hours i.v.) and collected a 24 h urine sample for examination of urinary tetrahydroaldosterone and aldosterone-18-glucuronide. Results: In hypokalaemic primary aldosteronism the saline infusion test showed a reasonable sensitivity (91%) and specificity (90%). However, the test failed to differentiate sufficiently between essential hypertension and normokalaemic primary aldosteronism (sensitivity 57%, specificity 90%). Similarly, urinary tetrahydroaldosterone had higher sensitivity in hypokalaemic than in normokalaemic primary aldosteronism (sensitivity 64% vs 36%, specificity 100%), whereas for aldosterone-18-glucuronide, no differences in hypo-and normokalaemic primary aldosteronism were found (sensitivity 45% and 43%, specificity 100%). Conclusions: These data show that the saline infusion test as an established test in classical hypokalaemic primary aldosteronism is not a reliable test in the normokalaemic variant of the disease. Due to its low accuracy, determination of urinary aldosterone metabolites did not prove useful in confirming either normo-or hypokalaemic patients. We conclude from our data that these tests should not be used as confirmatory testing in the normokalaemic variant of primary aldosteronism.European Journal of Endocrinology 154 865-873

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Review: Diagnosis and management of primary aldosteronism

Cited by 155 publications

References 103 publications

Prevalence of Primary Aldosteronism among Unselected Hypertensive Patients: A Prospective Study Based on the Use of an Aldosterone/Renin Ratio above 25 as a Screening Test

Prevalence of Primary Aldosteronism among Unselected Hypertensive Patients: A Prospective Study Based on the Use of an Aldosterone/Renin Ratio above 25 as a Screening Test

Indication and Technical Aspects of Adrenal Blood Sampling

Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites

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