Endocrine Abstracts

Introduction: Primary aldosteronism (PA) features a higher prevalence of cardiovascular events and renal complications as compared with essential hypertension. The effects of aldosterone excess on ascending aorta have never been investigated in human subjects.

Methods: From August 2014 to December 2015, we enrolled forty-seven consecutive PA outpatients who had not undergone surgery of the adrenal mass. Hypercortisolism and pheochromocytoma were excluded. All patients were ordered a trans-thoracic echocardiogram. Besides, an echocardiogram was requested to study forty-five consecutive hypertensive outpatients (at least on one antihypertensive drug) with an adrenal mass, after ruling out PA. They were considered essential hypertensive (EH) controls. Adrenal masses were studied in both groups with: 2-hour-upright-Aldosterone-to-Renin-Ratio (ARR) and, if positive, Captopril Challenge Test, the 1 mg dexamethasone suppression test, and 24-hour-acidified urinary metanephrines. We considered the presence of ascending aorta dilatation, which was defined as having an aortic root diameter higher than 37 mm and/or a tubular ascending aorta diameter superior to 36 mm.

Results: Forty-seven cases of PA and forty-five EH controls were assessed. In each group, the male-to-female ratio was 27/20 and 21/24, respectively. The groups did not differ in BMI, hypertensive cardiomyopathy, smoking history, adrenal morphology and creatinine. Ascending aorta dilatation was significantly higher in PA compared to EH controls, independently of age (36.2% vs 11.1%; odds-ratio=4.614, 95% CI 1.33–15.97; P=0.007). The difference was still significant when comparing males of either group (51.9% vs 19.0%; odds-ratio 4.577, 95% CI 1.22–17.22; P=0.034), whereas in females significance was not achieved.

Conclusion: Ascending aorta dilatation is more prevalent in males with PA than in EH controls, while in females with PA it is a rarer manifestation.