Endocrine Abstracts

Introduction

Primary hyperaldosteronism (PHA) is an increasingly prevalent cause of endocrine hypertension. It is characterized by unregulated aldosterone secretion with an excessive activation of mineralocorticoid receptors, inducing volume expansion, hypokalemia, endothelial dysfunction and fibrotic processes in the renal and cardiovascular systems. The aim of this study was to assess the metabolic, renal, and cardiovascular status in patients with primary hyperaldosteronism.

Methods

We conducted a retrospective study in 40 patients with a primary hyperaldosteronism (aldosterone-producing adenoma: n = 24; adrenal hyperplasia: n = 16). Clinical and biological data were collected. Electrocardiogram and cardiac ultrasound were analyzed in all participants. Cardiovascular risk was assessed using Framingham Risk Score (FRS).

Results

There were 24 (60%) women and 16 (40%) men, with a mean age at the diagnosis of hypertension of 40.3 ± 10.9 years. Overweight, obesity, prediabetes, diabetes mellitus, dyslipidemia, and metabolic syndrome were diagnosed in 37, 50, 30, 32, 45, and 70% of cases, respectively. Hypokalemia was present in 30 patients (75%). Kalemia was negatively correlated with plasma aldosterone level (r = –0.387; P = 0.015). Albuminuria and chronic renal failure were found in 53 and 17% of cases, respectively. The average 10-year FRS was 19.6 ± 12.3%. It was significantly correlated with age (r = 0.675, P < 10^–3), fasting glucose level (r = 0.395, P = 0.012), glycated hemoglobin (r = .503, P = 0.009), triglycerides level (r = 0.485, P = 0.002), and creatinine level (r = 0.502, P = 0.001). However, FRS was not correlated with aldosterone and renin levels. Twenty five percent of patients had a low risk, 20% had a moderate risk and 55 % had a high risk. Thirty percent of cases had a subepicardial ischemia, 63% had a left ventricular hypertrophy and 10% had a low left ventricular ejection fraction. A history of stroke was found in 17% of patients.

Conclusion

Primary hyperaldosteronism is associated with a high prevalence of metabolic disorders and renal disease. These complications are significantly associated with the cardiovascular risk.