Endocrine Abstracts

Primary aldosteronism (PHA) is one of the most common cause of secondary hypertension. It can possibly concern over 10% of hypertensive patients, but often is being under-recognised. The basic tool of case PHA detection is aldosterone to renin ratio (ARR). Appropriate cutoff value of ARR is still under discussion.

We review occurrence of CT/MRI detectable adrenal gland laesions according to assigned ARR cutoff value. Retrospective data from 833 consecutive hypertensive patients of average age 39.85 (S.D.:+/−15), 449 men and 384 women was analized. ARR>20, 30, 40 concerned respectively: 12.7%, 7.6%, 4.7%. CT/MRI was performed respectively in patients with ARR>20, 30, 40 in 55.7%, 66.7%, 69.2%. Laesions in adrenal glands in groups of ARR>20, 30, 40 concerned respectively: 47%, 52.4%, 56%. The most common CT/MRI findings were adenomas: respectively: 37.3%, 42.9%, 44.4% in groups of ARR>20, 30 and 40. Less common was nodular hypertrophia: respectively: 10.2%, 9.5%, 14.8% in groups >20, 30, and 40. The average potassium level in a group of ARR>20 was 4.05 (mmol/l) (S.D.:+/−0.46), >30 3.94 (S.D.:+/−0.50), >40 3.93 (S.D.:+/−0.55).

Average concentration of urine aldosterone in a group >20 was 14.36 (μg/24 h) (reference value 2.1–18.0 μg/24 h) (S.D.:+/−10.88), >30 15.72 (S.D.:+/−12.33), >40 17.71 (S.D.:+/−14.08).

Adrenal lesions in enlarged ARR group were notably more often than adrenal incidentalomas occurrence reported in population (47% vs 2–3%). Higher cutoff ARR value is more specific and allows to reduce costs of confirmative tests. If the ARR over >40 group we miss 16.95%, in ARR >30 group we miss 6.78% in compare to ARR>20. Can we afford missing them considering its’ increased cardiovascular risk?

In everyday PHA diagnostics practice there is still lack of “game changer” bringing the final conclusion for diagnostic and profilactic strategies for the whole hypertensive population.