Abstract
Primary aldosteronism (PA) is the most common secondary cause of hypertension, accounting for 10 % of hypertensives and 20 % of those with drug-resistant hypertension. Aldosterone excess is associated with the development of adverse cardiovascular, renal and metabolic effects that are partly independent of its effect on blood pressure. Guidelines recommended wider screening for PA in an effort to maximize detection of patients who may benefit from optimal, specific management. All patient groups with increased prevalence of PA, including hypertensive patients with type 2 diabetes mellitus and those with obstructive sleep apnea, should be carefully screened for PA. Screening with aldosterone-to-renin ratio (ARR) is the most practical and informative initial test. Subsequent confirmatory tests are: (1) oral salt loading; (2) saline infusion; (3) captopril challenge and (4) fludrocortisone suppression test. Confirmation of PA can avoid that patients with a false positive ARR would inappropriately undergo costly and harmful lateralization procedures. If confirmatory testing is positive, further investigations are directed toward determining the subtype of PA, as the treatment differs for each subtype.
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Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence of an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol. 2005;45(8):1243–8.
Fallo F, Federspil G, Veglio F, Mulatero P. The metabolic syndrome in primary aldosteronism. Curr Hypertens Rep. 2007;9(2):106–11.
Mulatero P, Monticone S, Bertello C, Viola A, Tiziani D, Iannaccone A, Crudo V, Burrello J, Milan A, Rabbia F, Veglio F. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab. 2013;98(12):4826–33.
Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, Young WF Jr, Montori VM, Endocrine Society. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(9):3266–81.
Mosso L, Carvajal C, Gonzàlez A, Barraza A, Avila F, Montero J, Huete A, Gederlini A, Fardella CE. Primary aldosteronism and hypertensive disease. Hypertension. 2003;42(2):161–5.
Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension. 2002;40(6):892–6.
Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, Ganzaroli C, Giacchetti G, Letizia C, Maccario M, Mallamaci F, Mannelli M, Mattarello MJ, Moretti A, Palumbo G, Parenti G, Porteri E, Semplicini A, Rizzoni D, Rossi E, Boscaro M, Pessina AC, Mantero F, PAPY Study Investigators. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293–300.
Mantero F, Terzolo M, Arnaldi G, Osella G, Masini AM, Giovagnetti M, Opocher G, Angeli A. A survey on adrenal incidentaloma in Italy. Study Group on Adrenal Tumors of the Italian Society of Endocrinology. J Clin Endocrinol Metab. 2000;85(2):637–44.
Stowasser M, Fallo F, So A, Jeske Y, Kelemen L, Pilon C, Gordon R. Genetic forms of primary aldosteronism. High Blood Press Cardiovasc Prev. 2007;14(2):75–81.
Monticone S, Else T, Mulatero P, Williams TA, Rainey WR. Understanding primary aldosteronism: impact of next generation sequencing and expression profiling. Mol Cell Endocrinol. 2015;399:311–20.
Conn JW. Hypertension, the potassium ion and impaired carbohydrate tolerance. N Engl J Med. 1965;273(21):1135–43.
Fallo F, Veglio F, Bertello C, Sonino N, Della Mea P, Ermani M, Rabbia F, Federspil G, Mulatero P. Prevalence and characteristics of the metabolic syndrome in primary aldosteronism. J Clin Endocrinol Metab. 2006;91(2):454–9.
Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A, Participants of the German Conn’s Registry. Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn’s Registry. Eur J Endocrinol. 2015;173(5):665–75.
Iacobellis G, Petramala L, Cotesta D, Pergolini M, Zinnamosca L, Cianci R, De Toma G, Sciomer S, Letizia C. Adipokines and cardiometabolic profile in primary hypealdosteronism. J Clin Endocrinol Metab. 2010;95(5):2391–8.
Fallo F, Pilon C, Urbanet R. Primary aldosteronism and metabolic syndrome. Horm Metab Res. 2012;44(3):208–14.
Petramala L, Pignatelli P, Carnevale R, Zinnamosca L, Marinelli C, Settevendemmie A, Concistrè A, Tonnarini G, De Toma G, Violi F, Letizia C. Oxidative stress in patients affected by primary aldosteronism. J Hypertens. 2014;32(10):2022–9.
Pratt-Ubunama M, Nishizaka MK, Boedefeld RL, Cofield SS, Harding SM, Calhoun DA. Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest. 2007;131(2):453–9.
Gaddam K, Pimenta E, Thomas SJ, Cofield SS, Oparil S, Harding SM, Calhoun DA. Spironolactone reduces severity of obstructive sleep apnea in patients with resistant hypertension: a preliminary report. J Hum Hypertens. 2010;24(8):532–7.
Di Murro A, Petramala L, Cotesta D, Zinnamosca L, Crescenzi E, Marinelli C, Saponara M, Letizia C. Renin–angiotensin–aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism. J Renin Angiotensin Aldosterone Syst. 2010;11(3):165–72.
Manolopoulou J, Fischer E, Dietz A, Diederich S, Holmes D, Junnila R, Grimminger P, Reincke M, Morganti A, Bidlingmaier M. Clinical validation for the aldosterone-to-renin ratio and aldosterone suppression testing using simultaneous fully automated chemiluminescence immunoassays. J Hypertens. 2015;33(12):2500–11.
Mulatero P, Monticone S, Bertello C, Mengozzi G, Tizzani D, Iannaccone A, Crudo V, Veglio F. Confirmatory tests in the diagnosis of primary aldosteronism. Horm Metab Res. 2010;42(6):406–10.
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Sabbadin, C., Fallo, F. Hyperaldosteronism: Screening and Diagnostic Tests. High Blood Press Cardiovasc Prev 23, 69–72 (2016). https://doi.org/10.1007/s40292-016-0136-5
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DOI: https://doi.org/10.1007/s40292-016-0136-5