Endocrine Abstracts

Primary aldosteronism has been recognized as a common cause of secondary hypertension, accounting for approximately 10% of patients in hypertension clinics and 5% in primary care. Long-standing aldosteronism is associated with refractory hypertension, severe hypokalemia, and consecutive cardiovascular consequences: atrial fibrillation, myocardial infarction, heart failure, stroke, and renal failure. Less well-recognized features of primary aldosteronism is impaired quality of life, depression and anxiety, insulin resistance and diabetes mellitus, and disturbances of calcium metabolism. Screening should be applied in hypertensive patients presenting with one of the following: hypokalemia, refractory hypertension, suggestive family history, or an incidentally detected adrenal mass. The most advocated screening test at present is the aldosterone to-renin ratio, which has a high sensitivity but low specificity. The specificity increases if patients with low aldosterone concentrations are excluded. Published cut-off values vary depending on the hormone assay and the investigated population. Before screening, antihypertensive treatment, especially aldosterone antagonists and β-blockers, should be discontinued if clinically feasible and safe. A pathologic result requires additional work up to prove mineralocorticoid excess. Subtype differentiation is performed by adrenal venous sampling combined with imaging (CT or MRI). One-third of cases (70% in hypokalemic series) are due to aldosterone-producing adenomas, for which the preferred treatment is laparoscopic adrenalectomy.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.