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High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients.
J Hypertens. 2003 Nov; 21(11):2149-57.JH

Abstract

BACKGROUND

Wide testing of the aldosterone : renin ratio among hypertensive individuals has revealed primary aldosteronism to be common, with most patients normokalaemic. Some investigators, however, have reported aldosterone-producing adenoma to be rare among patients so detected.

OBJECTIVE

To test the hypothesis that differences among reported studies in the rate of detection of aldosterone-producing adenoma (as opposed to bilateral adrenal hyperplasia) reflect differences in the procedures used for diagnosis of primary aldosteronism, and the methods used to identify aldosterone-producing adenomas.

METHODS

In the newly established Princess Alexandra Hospital Hypertension Unit (PAHHU), we used procedures developed by Greenslopes Hospital Hypertension Unit (which reports that more than 30% of patients with primary aldosteronism have aldosterone-producing adenomas) to diagnose primary aldosteronism and determine the subtype. All patients with an increased aldosterone : renin ratio (measured after correction for hypokalaemia and while the patient was not receiving interfering medications) underwent fludrocortisone suppression testing to confirm or exclude primary aldosteronism; if they were positive, they underwent genetic testing to exclude glucocorticoid-remediable aldosteronism before adrenal venous sampling was used to differentiate lateralizing from bilateral primary aldosteronism.

RESULTS

This approach allowed PAHHU to diagnose, within 2 years, 54 patients [only seven (13%) hypokalaemic] with primary aldosteronism. All tested negative for glucocorticoid-remediable aldosteronism. Aldosterone production was lateralized to one adrenal in 15 patients (31%; only six hypokalaemic) and was bilateral in 34 (69%; all normokalaemic) of 49 patients who underwent adrenal venous sampling. Among patients with lateralizing adrenal hyperplasia, computed tomography revealed an ipsilateral mass in only six and a contralateral lesion in one. Fourteen patients underwent unilateral adrenalectomy, which cured the hypertension in seven and improved it in the remainder. In patients with bilateral primary aldosteronism, hypertension responded to spironolactone (12.5-50 mg/day) or amiloride (2.5-10 mg/day).

CONCLUSION

When performed with careful regard to confounding factors, measurement of the aldosterone : renin ratio in all hypertensive individuals, followed by fludrocortisone suppression testing to confirm or exclude primary aldosteronism and adrenal venous sampling to determine the subtype, can result in the detection of significant numbers of patients with specifically treatable or potentially curable hypertension.

Authors+Show Affiliations

Hypertension Unit, University of Queensland Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia. m.stowasser@uq.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14597859

Citation

Stowasser, Michael, et al. "High Rate of Detection of Primary Aldosteronism, Including Surgically Treatable Forms, After 'non-selective' Screening of Hypertensive Patients." Journal of Hypertension, vol. 21, no. 11, 2003, pp. 2149-57.
Stowasser M, Gordon RD, Gunasekera TG, et al. High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients. J Hypertens. 2003;21(11):2149-57.
Stowasser, M., Gordon, R. D., Gunasekera, T. G., Cowley, D. C., Ward, G., Archibald, C., & Smithers, B. M. (2003). High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients. Journal of Hypertension, 21(11), 2149-57.
Stowasser M, et al. High Rate of Detection of Primary Aldosteronism, Including Surgically Treatable Forms, After 'non-selective' Screening of Hypertensive Patients. J Hypertens. 2003;21(11):2149-57. PubMed PMID: 14597859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients. AU - Stowasser,Michael, AU - Gordon,Richard D, AU - Gunasekera,Thanuja G, AU - Cowley,Diane C, AU - Ward,Gregory, AU - Archibald,Colin, AU - Smithers,B Mark, PY - 2003/11/5/pubmed PY - 2004/7/13/medline PY - 2003/11/5/entrez SP - 2149 EP - 57 JF - Journal of hypertension JO - J Hypertens VL - 21 IS - 11 N2 - BACKGROUND: Wide testing of the aldosterone : renin ratio among hypertensive individuals has revealed primary aldosteronism to be common, with most patients normokalaemic. Some investigators, however, have reported aldosterone-producing adenoma to be rare among patients so detected. OBJECTIVE: To test the hypothesis that differences among reported studies in the rate of detection of aldosterone-producing adenoma (as opposed to bilateral adrenal hyperplasia) reflect differences in the procedures used for diagnosis of primary aldosteronism, and the methods used to identify aldosterone-producing adenomas. METHODS: In the newly established Princess Alexandra Hospital Hypertension Unit (PAHHU), we used procedures developed by Greenslopes Hospital Hypertension Unit (which reports that more than 30% of patients with primary aldosteronism have aldosterone-producing adenomas) to diagnose primary aldosteronism and determine the subtype. All patients with an increased aldosterone : renin ratio (measured after correction for hypokalaemia and while the patient was not receiving interfering medications) underwent fludrocortisone suppression testing to confirm or exclude primary aldosteronism; if they were positive, they underwent genetic testing to exclude glucocorticoid-remediable aldosteronism before adrenal venous sampling was used to differentiate lateralizing from bilateral primary aldosteronism. RESULTS: This approach allowed PAHHU to diagnose, within 2 years, 54 patients [only seven (13%) hypokalaemic] with primary aldosteronism. All tested negative for glucocorticoid-remediable aldosteronism. Aldosterone production was lateralized to one adrenal in 15 patients (31%; only six hypokalaemic) and was bilateral in 34 (69%; all normokalaemic) of 49 patients who underwent adrenal venous sampling. Among patients with lateralizing adrenal hyperplasia, computed tomography revealed an ipsilateral mass in only six and a contralateral lesion in one. Fourteen patients underwent unilateral adrenalectomy, which cured the hypertension in seven and improved it in the remainder. In patients with bilateral primary aldosteronism, hypertension responded to spironolactone (12.5-50 mg/day) or amiloride (2.5-10 mg/day). CONCLUSION: When performed with careful regard to confounding factors, measurement of the aldosterone : renin ratio in all hypertensive individuals, followed by fludrocortisone suppression testing to confirm or exclude primary aldosteronism and adrenal venous sampling to determine the subtype, can result in the detection of significant numbers of patients with specifically treatable or potentially curable hypertension. SN - 0263-6352 UR - https://www.unboundmedicine.com/medline/citation/14597859/High_rate_of_detection_of_primary_aldosteronism_including_surgically_treatable_forms_after_'non_selective'_screening_of_hypertensive_patients_ L2 - https://doi.org/10.1097/00004872-200311000-00025 DB - PRIME DP - Unbound Medicine ER -