High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients

Stowasser, Michael, Gordon, Richard D., Gunasekera, Thanuja G., Cowley, Diane C., Ward, Gregory, Archibald, Colin and Smithers, B. Mark (2003) High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients. Journal of Hypertension, 21 11: 2149-2157. doi:10.1097/01.hjh.0000098141.70956.53

Author Stowasser, Michael
Gordon, Richard D.
Gunasekera, Thanuja G.
Cowley, Diane C.
Ward, Gregory
Archibald, Colin
Smithers, B. Mark
Title High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients
Journal name Journal of Hypertension   Check publisher's open access policy
ISSN 0263-6352
Publication date 2003-11-01
Sub-type Article (original research)
DOI 10.1097/01.hjh.0000098141.70956.53
Volume 21
Issue 11
Start page 2149
End page 2157
Total pages 9
Place of publication Philadelphia, U.S.
Publisher Lippincott Williams & Wilkins
Language eng
Subject C1
321003 Cardiology (incl. Cardiovascular Diseases)
730106 Cardiovascular system and diseases
1103 Clinical Sciences
110306 Endocrinology
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 aldlosteronism, hypertension responded to spironolactone (112.5-50 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. (C) 2003 Lippincott Williams Wilkins.
Keyword Peripheral Vascular Disease
Adrenal Venous Sampling
Aldosterone-producing Adenoma
Renin Ratio
Bilateral Adrenal Hyperplasia
Diagnosis Hyperaldosteronism
Primary Aldosteronism
Primary Hyperaldosteronism
Plasma Aldosterone
High Prevalence
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2004 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 166 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 199 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 11:36:53 EST