Almeida1,2 abstract primary aldosteronism pa is the most common form of secondary hypertension htn, with an estimated prevalence of 4% of hypertensive patients in primary care and. The first page of the pdf of this article appears above. Primary aldosteronism has provoked a great deal of interest since first described. Aldosterone excess induces sodium and fluid retention with consequential increases in blood pressure. Primary aldosteronism pa, first described by jerome w. Primary aldosteronism aldostuhronizum is a hormonal disorder that leads to high blood pressure. Objectives this study prospectively investigated the prevalence, characteristics, and outcomes of pa in newly diagnosed hypertensive patients. The algorithm starts with clinical screening of patients with a high pretest probability of primary aldosteronism pa in whom to perform the screening tests. Primary aldosteronism resulting from an adrenocortical adenoma aldosteronoma, as described by conn,1 is one of a few potentially curable forms of hypertension. Aldosterone has been reported to increase in the luteal phase in normal women but to our knowledge the influence of the ovarian cycle on the first screening for primary aldosteronism that is, on. The application of the current screening method of an elevated plasma aldosterone torenin ratio arr to a wider target population instead of. We identified 31 studies including 3838 patients with primary aldosteronism and 9284 patients with essential hypertension. Patients with pa are at an increased risk of developing left ventricular hypertrophy, chronic kidney disease, and endothelial dysfunction. But often, the number of medicines or doses can be lowered.
Primary aldosteronism guideline resources endocrine society. Primary aldosteronism hyperaldosteronism is a condition that occurs when the adrenal glands produce too much aldosterone, the hormone responsible for balancing potassium and sodium in the body. Conn in 1955, was once thought to be a rare condition of hypertension characterized by hypokalemia and excess aldosterone production relative to suppressed plasma renin. Primary aldosteronism symptoms, diagnosis and treatment. Observations on a presumptive case of primary aldosteronism. This extremely potent sodiumretaining corticoid has been found to be present in excessive amounts in the urine of edematous nephrotics, 7, 8 cardiacs with congestive. Primary aldosteronism pal is characterized by excessive production of aldosterone, which leads to hypernatremia, hypertension htn, hypokalemia, and alkalosis. Removing the adrenal tumor may control the symptoms. In experimental animal models, exogenous aldosterone excess has been linked to the progression of renal disease. Nonetheless, a similar lack of aldosterone suppressibility after either oral salt loading for 3 days or oral administration of a single 25mg dose of captopril may help achieve the same purpose.
Primary aldosteronism, a new clinical entity annals. Primary aldosteronism pa is a common, but frequently overlooked, cause of arterial hypertension and excess cardiovascular events, particularly atrial fibrillation. However, the evidence of an increased risk of renal damage in patients affected by primary aldosteronism remains controversial. Even after surgery, some people still have high blood pressure and need to take medicine. Diagnosis and management of primary aldosteronism leticia a. This abnormality is caused by hyperplasia or tumors.
Primary and nonsuppressible hypersecretion of aldosterone is an increasingly recognized, but still underdiagnosed, cause of hypertension. Primary aldosteronism is the most common form of secondary hypertension. Primary aldosteronism is an underdiagnosed cause of endocrine hypertension. The deleterious effects of primary aldosteronism are mediated by excessive activation of the mineralocorticoid receptor that results in the wellknown consequences of volume expansion, hypertension, hypokalemia, and metabolic alkalosis. The occurrence of pa within families is in keeping with a genetic basis for at least some forms of this condition. The most common subtypes of primary aldosteronism are. Recent studies have indicated a higher prevalence of primary aldosteronism pa than reported historically. To develop clinical practice guidelines for the management of patients with primary aldosteronism. Primary aldosteronism pa is the most common form of secondary hypertension. Primary hyperaldosteronism caused by an adrenal gland tumor is usually treated with surgery. Retrospective analysis of the following data from 82 patients with primary aldosteronism. Primary aldosteronism hyperaldosteronism cedarssinai. Many suffer from fatigue, potassium deficiency and high blood pressure which may cause poor vision, confusion or headaches. Lack of appropriate suppression of plasma aldosterone after saline infusion is thought to be the best maneuver for confirming primary aldosteronism.
Among patient cohorts with resistant hypertension, primary aldosteronism may be present in 10% to 20%,15, 16 and among lessselected populations of patients with mild to moderate hypertension e. The tests should be highly sensitive to not miss cases, but because of. Primary aldosteronism as described by conn in 1955 had been thought to be an uncommon cause of hypertension, with a prevalence of primary aldosteronism has been found to be. In many cases, somatic mutations in ion channels and pumps within adrenal cells initiate the pathogenesis of pa, and this mechanism might explain why pa is so common and suggests that milder and evolving forms of pa must exist. Diagnosis and management of primary aldosteronism michael stowasser, richard d gordon, john c rutherford, nik z nikwan, nicholas daunt, and gregory j slater journal of the reninangiotensin aldosterone system 2001 2. Marked improvement or cure of htn is achieved with appropriate treatment. Primary aldosteronism pal is a clinical disorder characterized by excessive production and release of aldosterone from the cortical zona glomerulosa of the adrenal gland. Your adrenal glands produce a number of essential hormones, including aldosterone.
In primary aldosteronism pa, aldosterone production exceeds the bodys requirements and is relatively autonomous with regard to its normal chronic regulator, the reninangiotensin ii system. The task force included a chair, selected by the clinical guidelines subcommittee of the endocrine society, six additional experts, a methodologist, and a medical writer. The classic presenting signs of primary aldosteronism are hypertension and hypokalemia, but potassium levels are frequently normal in modernday series of primary aldosteronism. Primary aldosteronism is characterized by the excess production of aldosterone and may be found in 5% to % of all hypertensive patients. Overproduction of aldosterone causes the body to retain more sodium and lose potassium, which leads to elevated blood pressure. Aldosteronism and hypertension american society of. The guideline was cosponsored by american heart association, american. Primary aldosteronism in a 9yearold child american. Primary aldosteronism occurs in 5% to 10% of all hypertensive patients and is a common cause of secondary and endocrine hypertension although in youngerparticularly femalepatients, it most commonly causes renal artery stenosis. Primary aldosteronism and hypertensive disease hypertension. Primary aldosteronism pa, the most common form of secondary hypertension, can be either surgically cured or treated with targeted pharmacotherapy. Primary hyperaldosteronism an overview sciencedirect. Diagnosis and treatment of primary hyperaldosteronism. Primary aldosteronism pa, also known as primary hyperaldosteronism or conns syndrome, refers to the excess production of the hormone aldosterone from the adrenal glands, resulting in low renin levels.
As timely diagnosis and treatment can provide a cure of hyperaldosteronism and hypertension, even when the latter is resistant to drug treatment, strategies to screen patients for pa early with a simplified diagnostic algorithm. Although estimates vary 2, the prevalence of pa is approximately 5% in patients with hypertension 3 and up to 20% in those with treatment. The classic presenting signs of primary aldosteronism are hypertension and hypokalemia, but potassium levels are frequently normal in current series of primary aldosteronism. We aimed at evaluating the association between primary aldosteronism and renal damage through a metaanalysis. Nonsuppressible primary hypersecretion of aldosterone is an underdiagnosed cause of hypertension. Hypertension, increased adrenal aldosterone secretion and suppressed renin are the three hallmarks of primary aldosteronism pa, which was first fully described in 1955 1. Shortened saline infusion test for subtype prediction in. Methods in a large community health center, consecutive hypertensive patients with an. It occurs when your adrenal glands produce too much of a hormone called aldosterone. Cardiovascular events and target organ damage in primary. Aldosteronerenin ratio in the assessment of primary.
Recent studies have demonstrated that primary aldosteronism pa is the most common form of secondary hypertension when determinations of serum aldosterone sa, plasma renin activity pra, and the sapra ratio are used as screening tools and the fludrocortisone, saline infusion, or captopril tests are used to confirm the diagnosis. Usually, aldosterone balances sodium and potassium in your blood. After a median of 88 years iqr 62107 from the diagnosis of hypertension, compared with patients with essential hypertension, patients with primary aldosteronism had an increased risk of stroke odds ratio or 258, 95% ci 193345, coronary artery. Although there is no established threshold for an abnormal result. Moreover, patients with primary aldosteronism had lower heart rates and higher blood pressure and vascular resistance values than did those with the secondary condition, while plasma renin activity was lower in primary than in secondary aldosteronism 0. Primary aldosteronism and its relationship to diabetes mellitus. Primary aldosteronism is characterized by aldosterone secretion that is independent of renin and angiotensin ii and sodium status. In many cases, somatic mutations in ion channels and pumps within adrenal cells initiate the pathogenesis of pa, and this mechanism might explain why pa is so common and. Primary hyperaldosteronism is the most common cause of secondary hypertension with hypokalemia and is distinguished from liddle syndrome by the elevated serum and urine aldosterone levels that are not suppressible on a highsalt diet, and an elevated serum aldosterone. Three crucial diagnostic steps include case detection, case confirmation, and subtype classification. Mantero, primary aldosteronism, prevalence in italy study investigators, comparison of the captopril and the saline infusion test for. Primary aldosteronism and its relationship to diabetes. Learn which patients should be tested for this condition with the endocrine societys guideline, the management of primary aldosteronism.