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Sun K, Zhou C, Gong M, Zhang Y, Jiang Y, Song W. The prevalence of metabolic syndrome in primary aldosteronism and essential hypertension: A systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2024. [PMID: 39037169 DOI: 10.1111/jch.14873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/30/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
It remained debates on metabolic-related disorders in patients with primary aldosteronism (PA) and essential hypertension (EH). A systematic review and meta-analysis was conducted to explore the prevalence of metabolic syndrome (MS) and the related indicators in PA and EH. PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials from their commencement to December 2023 were searched for eligible studies. The meta-analysis was performed by Review Manager 5.3 and STATA 15.1 software. A total of 12 studies were included, revealing that there was no significant difference between PA and EH in the prevalence of MS (1.27[0.92, 1.76], p = 0.14) with higher heterogeneity (I2 = 68%, p = 0.0002), while it became significant different (1.45[1.17, 1.81], p = 0.0008) and lower heterogeneity (I2 = 26%, p = 0.19) in patients who were overweight or obese by subgroup analysis. Higher systolic blood pressure (2.99[0.67, 5.31], p = 0.01; I2 = 43%, p = 0.06) and diastolic blood pressure (2.10[0.82, 3.38], p = 0.001; I2 = 36%, p = 0.11) with lower heterogeneity, and lower triglyceride in PA group with higher heterogeneity (-0.23[-0.37, -0.09], p = 0.001; I2 = 76%, p < 0.0001) were observed. No significant difference was found in other indicators. This study showed a higher prevalence of MS in patients who were overweight or obese with PA. However, it was not the same in these patients who were in normal weight. More researches were needed to explore the relationship between PA and metabolism of glucose and lipid.
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Affiliation(s)
- Kaiwen Sun
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Chenxu Zhou
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Minghui Gong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ying Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yinong Jiang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Wei Song
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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2
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Hua Y, He Q. Comparison between screening for primary aldosteronism with and without drug adjustment. Blood Press 2024; 33:2350981. [PMID: 38824645 DOI: 10.1080/08037051.2024.2350981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/29/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Few studies have evaluated the performance of non-drug-adjusted primary aldosteronism (PA) screening. Therefore, we aimed to examine the consistency between PA screening results with and without drug adjustment and to explore the effectiveness of screening without drug adjustment. METHODS This prospective study included 650 consecutive patients with a high risk of incidence PA. Patients who initially screened positive underwent rescreening with drug adjustments and confirmatory tests. Regarding the remaining patients, one of every three consecutive patients underwent rescreening with drug adjustments and confirmatory tests. The changes in aldosterone and renin concentrations were compared between patients with essential hypertension (EH) and those with PA before and after drug adjustment. Sensitivity and specificity were used to assess the diagnostic performance of screening without drug adjustment, using the confirmatory test results as the reference. RESULTS We screened 650 patients with hypertension for PA. Forty-nine patients were diagnosed with PA and 195 with EH. Regarding drugs, 519 patients were taking angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), or diuretics alone or in combination. Forty-one patients were taking beta-blockers. Ninety patients were taking beta-blockers in combination with other drugs. In patients treated with ACEIs, ARBs, CCBs, or diuretics alone, or in combination, or beta-blockers alone, PA positivity was determined using the criteria, aldosterone-to-renin ratio (ARR) >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, and negativity, using the criteria, ARR <9 pg/mL/pg/mL; the sensitivity and specificity were 94.7% and 94.5%, respectively. After drug adjustment, the sensitivity and specificity of screening were 92.1% and 89%, respectively. CONCLUSIONS In patients not treated with beta-blockers combined with others, when ARR >38 pg/mL/pg/mL and plasma aldosterone concentration (PAC) >100 pg/mL, or, ARR <9 pg/mL/pg/mL, non-drug-adjusted screening results were identical to with drug adjustment. Non-drug-adjusted screening could reduce the chance of medication adjustment, enable patients to continue their treatments and avoiding adverse effects, is of clinical importance.
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Affiliation(s)
- Yanlong Hua
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing He
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
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Mulatero P, Scholl UI, Fardella CE, Charmandari E, Januszewicz A, Reincke M, Gomez-Sanchez CE, Stowasser M, Dekkers OM. Familial hyperaldosteronism: an European Reference Network on Rare Endocrine Conditions clinical practice guideline. Eur J Endocrinol 2024; 190:G1-G14. [PMID: 38571460 DOI: 10.1093/ejendo/lvae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
We describe herein the European Reference Network on Rare Endocrine Conditions clinical practice guideline on diagnosis and management of familial forms of hyperaldosteronism. The guideline panel consisted of 10 experts in primary aldosteronism, endocrine hypertension, paediatric endocrinology, and cardiology as well as a methodologist. A systematic literature search was conducted, and because of the rarity of the condition, most recommendations were based on expert opinion and small patient series. The guideline includes a brief description of the genetics and molecular pathophysiology associated with each condition, the patients to be screened, and how to screen. Diagnostic and treatment approaches for patients with genetically determined diagnosis are presented. The recommendations apply to patients with genetically proven familial hyperaldosteronism and not to families with more than one case of primary aldosteronism without demonstration of a responsible pathogenic variant.
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Affiliation(s)
- Paolo Mulatero
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Ute I Scholl
- Center of Functional Genomics, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Carlos E Fardella
- Department of Endocrinology, School of Medicine, Centro Traslacional de Endocrinología Universidad Católica (CETREN-UC), Pontificia Universidad Católica de Chile, 8330033 Santiago, Chile
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, Athens 11527, Greece
- Division of Endocrinology and Metabolism, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens 11527, Greece
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, 02-628 Warsaw, Poland
| | - Martin Reincke
- Department of Medicine 4, LMU University Hospital, LMU Munich, Munich D-80336, Germany
| | - Celso E Gomez-Sanchez
- Research Service, G. V. (Sonny) Montgomery VA Medical Center, Jackson, MS 39216, United States
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, 39216 MS, United States
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Frazer Institute, Greenslopes and Princess Alexandra Hospitals, Brisbane, 4102 Queensland, Australia
| | - Olaf M Dekkers
- Departments of Clinical Epidemiology and Internal Medicine, Leiden University Medical Centre, 2311 Leiden, The Netherlands
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4
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Sun K, Gong M, Yu Y, Yang M, Zhang Y, Jiang Y, Song W. Comparison of saline infusion test and captopril challenge test in the diagnosis of Chinese with primary aldosteronism in different age groups. Front Endocrinol (Lausanne) 2024; 15:1343704. [PMID: 38586461 PMCID: PMC10995348 DOI: 10.3389/fendo.2024.1343704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
Background To explore the diagnostic accuracy and the optimal cutoff value between the saline infusion test (SIT) and captopril challenge test (CCT) [including the value and suppression of plasma aldosterone concentration (PAC)] for primary aldosteronism (PA) diagnosing. Methods A total of 318 patients with hypertension were consecutively enrolled, including 126 patients with PA and 192 patients with essential hypertension (EH), in this observational study. The characteristics of patients and laboratory examinations were collected and compared. The comparison between SIT and CCT was carried by drawing the receiver operator characteristic curve (ROC) and calculating the area under the curve (AUC) to explore the diagnostic accuracy and the optimal cutoff value. Results The average age was 51.59 ± 10.43 in the PA group and 45.72 ± 12.44 in the EH group (p<0.05). The optimal cutoff value was 10.7 ng/dL for post-CCT PAC, 6.8 ng/dL for post-SIT PAC, and 26.9% for suppression of post-CCT PAC. The diagnostic value of post-CCT PAC was the highest with 0.831 for the AUC and 0.552 for the Youden index. The optimal cutoff value for patients who were <50 years old was 11.5 ng/dL for post-CCT PAC and 8.4 ng/dL for post-SIT PAC. The suppression of post-CCT PAC turned to 18.2% for those of age 50 or older. Conclusion Compared with SIT, CCT had a higher diagnostic value when post-CCT PAC was used as the diagnostic criterion in Chinese people, while the selection of diagnostic thresholds depended on patient age.
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Affiliation(s)
| | | | | | | | | | - Yinong Jiang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Wei Song
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Aune A, Ohldieck A, Halvorsen LV, Brobak KM, Olsen E, Rognstad S, Larstorp ACK, Søraas CL, Rossebø AB, Rösner A, Grytaas MA, Gerdts E. Gender Differences in Cardiac Organ Damage in Arterial Hypertension: Assessing the Role of Drug Nonadherence. High Blood Press Cardiovasc Prev 2024; 31:157-166. [PMID: 38530572 PMCID: PMC11043164 DOI: 10.1007/s40292-024-00632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/03/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Cardiac organ damage like left ventricular (LV) hypertrophy and left atrial (LA) enlargement is more prevalent in women than men with hypertension, but the mechanisms underlying this gender difference remain unclear. METHODS We tested the association of drug nonadherence with the presence of LV hypertrophy and LA enlargement by echocardiography in 186 women and 337 men with uncontrolled hypertension defined as daytime systolic blood pressure (BP) ≥ 135mmHg despite the prescription of at least two antihypertensive drugs. Drug adherence was assessed by measurements of serum drug concentrations interpreted by an experienced pharmacologist. Aldosterone-renin-ratio (ARR) was measured on actual medication. RESULTS Women had a higher prevalence of LV hypertrophy (46% vs. 33%) and LA enlargement (79% vs 65%, both p < 0.05) than men, while drug nonadherence (8% vs. 9%, p > 0.514) did not differ. Women were older and had lower serum renin concentration and higher ARR than men, while 24-h systolic BP (141 ± 9 mmHg vs. 142 ± 9 mmHg), and the prevalences of obesity (43% vs. 50%) did not differ (all p > 0.10). In multivariable analyses, female gender was independently associated with a two-fold increased risk of LV hypertrophy (OR 2.01[95% CI 1.30-3.10], p = 0.002) and LA enlargement (OR 1.90 [95% CI 1.17-3.10], p = 0.010), while no association with drug nonadherence was found. Higher ARR was independently associated with LV hypertrophy in men only (OR 2.12 [95% CI 1.12-4.00] p = 0.02). CONCLUSIONS Among patients with uncontrolled hypertension, the higher prevalence of LV hypertrophy and LA enlargement in women was not explained by differences in drug nonadherence. REGISTRATION URL: https://www. CLINICALTRIALS gov ; Unique identifier: NCT03209154.
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Affiliation(s)
- Arleen Aune
- Department of Clinical Sciences, University of Bergen, P.P. box 7804, 5020, Bergen, Norway.
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | - Annabel Ohldieck
- Department of Clinical Sciences, University of Bergen, P.P. box 7804, 5020, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Lene V Halvorsen
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Karl Marius Brobak
- Section of Nephrology, The Arctic University of Norway, Tromsø, Norway
- Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eirik Olsen
- Department of Emergency Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Stine Rognstad
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Department of Pharmacology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | - Camilla L Søraas
- Section for Cardiovascular and Renal Research, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Environmental and Occupational Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anne B Rossebø
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Assami Rösner
- Department of Clinical Medicine, UIT, The Arctic University, Tromsø, Norway
| | | | - Eva Gerdts
- Department of Clinical Sciences, University of Bergen, P.P. box 7804, 5020, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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6
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Li J, Yan H, Li L, Lin X, Zhao Z, Zhou C, Zhang Q. Practical recommendations for antihypertensive therapy during the primary aldosteronism screening test. Endocrine 2024; 83:188-195. [PMID: 37924464 DOI: 10.1007/s12020-023-03580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND The aldosterone-to-renin activity ratio (ARR) is recommended as a screening test for primary aldosteronism (PA). The use of antihypertensive medication is one of the most important factors to take into account when interpreting the ARR. OBJECTIVES The goal of this study was to compare the effect of various antihypertensive drug classes on biochemical testing and provide practical recommendations for antihypertensive medication regimens in patients suspected of having PA. METHODS We retrospectively investigated 4218 hypertensive patients who underwent PA detection between January 2020 and February 2023. Finally, 25 patients with essential hypertension (EH) and 39 with PA were involved. The enrolled EH patients were selected from EH patients with at least two screening tests with interfering medication changes for at least 4 weeks. RESULTS A total of 2/18 (11.1%) EH patients had opposite screening results after angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), dihydropyridine-calcium channel blockers (DHP-CCBs) and diuretics were withdrawn. A total of 3/3 (100%) of the patients were initially screened as positive but had results that tested negative after β-blockers withdrawal. A total of 3/39 (7.7%) PA patients were misdiagnosed with EH with drug effects. Only plasma renin activity was markedly reduced after antihypertensive medication washout (P = 0.0173). CONCLUSIONS Not every patient receiving β-blockers, ACEIs, ARBs and DHP-CCBs with negative reports needed withdrawal or switching antihypertensive drugs. We recommend that patients be left on a regimen that includes β-blockers, ACEIs, ARBs, DHP-CCBs and spironolactone when determining the ARR during the initial test.
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Affiliation(s)
- Jialin Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, China
| | - Hongzhou Yan
- Zhejiang Lab, Hangzhou City, Zhejiang Province, China
| | - Ling Li
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Ningbo University, Ningbo City, Zhejiang Province, China
| | - Xiuwen Lin
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou City, Zhejiang Province, China
| | - Zheng Zhao
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou City, Zhejiang Province, China
| | - Cheng Zhou
- Department of Urology, The First Affiliated Hospital of Ningbo University, Ningbo city, Zhejiang province, China
| | - Qi Zhang
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou City, Zhejiang Province, China.
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Freitas TC, Maciel AAW, Fagundes GFC, Petenuci J, Santana LS, Guimaraes AG, Freitas-Castro F, Srougi V, Tanno FY, Chambo JL, Pereira MAA, Brito LP, Pio-Abreu A, Bortolotto LA, Latronico AC, Fragoso MCBV, Drager LF, Mendonca BB, Almeida MQ. Efficacy of Oral Furosemide Test for Primary Aldosteronism Diagnosis. J Endocr Soc 2023; 8:bvad147. [PMID: 38075562 PMCID: PMC10701630 DOI: 10.1210/jendso/bvad147] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Indexed: 01/06/2024] Open
Abstract
Context Confirmatory tests represent a fundamental step in primary aldosteronism (PA) diagnosis, but they are laborious and often require a hospital environment due to the risks involved. Objective To evaluate the efficacy of oral furosemide as a new confirmatory test for PA diagnosis. Methods We prospectively evaluated the diagnostic performance of 80 mg of oral furosemide in 64 patients with PA and 22 with primary hypertension (controls). Direct renin concentration (DRC) was measured before, and 2 hours and 3 hours after the oral furosemide. In addition, the oral furosemide test was compared with 2 other confirmatory tests: the furosemide upright test (FUT) and saline infusion test (SIT) or captopril challenge test (CCT) in all patients with PA. Results The cut-off of 7.6 µU/mL for DRC at 2 hours after oral furosemide had a sensitivity of 92%, specificity of 82%, and accuracy of 90% for PA diagnosis. In 5 out of 6 controls with low-renin hypertension, which might represent a PA spectrum, renin remained suppressed. Excluding these 6 controls with low-renin hypertension, the DRC cut-off of 10 µU/mL at 2 hours after oral furosemide had a sensitivity of 95.3%, specificity of 93.7% and accuracy of 95% for PA diagnosis. DRC after 3 hours of oral furosemide did not improve diagnostic performance. Using the cut-off of 10 µU/mL, the oral furosemide test and the FUT were concordant in 62 out of 64 (97%) patients with PA. Only 4 out of 64 cases with PA (6.4%) ended the oral furosemide test with potassium <3.5 mEq/L. Hypotension was not evidenced in any patient with PA during the test. Conclusion The oral furosemide test was safe, well-tolerated and represents an effective strategy for PA investigation.
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Affiliation(s)
- Thais C Freitas
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Ana Alice W Maciel
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Gustavo F C Fagundes
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Janaina Petenuci
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Lucas S Santana
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Augusto G Guimaraes
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Felipe Freitas-Castro
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Victor Srougi
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Fabio Y Tanno
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Jose L Chambo
- Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Maria Adelaide A Pereira
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Luciana P Brito
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Andrea Pio-Abreu
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Luiz A Bortolotto
- Unidade de Hipertensão, Instituto do Coração (InCor), Faculdade de Medicna da Universidade de São Paulo, São Paulo, 05403-900, Brazil
| | - Ana Claudia Latronico
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Maria Candida B V Fragoso
- Divisão de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
- Divisão de Oncologia Endócrina, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-000, Brazil
| | - Luciano F Drager
- Unidade de Hipertensão, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
- Unidade de Hipertensão, Instituto do Coração (InCor), Faculdade de Medicna da Universidade de São Paulo, São Paulo, 05403-900, Brazil
| | - Berenice B Mendonca
- Divisão de Endocrinologia e Metabologia, Laboratório de Hormônios e Genética Molecular LIM/42, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
| | - Madson Q Almeida
- Divisão de Endocrinologia e Metabologia, Hospital das Clínicas, Unidade de Adrenal, Laboratório de Endocrinologia Molecular e Celular LIM/25, Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brazil
- Divisão de Oncologia Endócrina, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, 01246-000, Brazil
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Shoemaker R, Poglitsch M, Davis D, Huang H, Schadler A, Patel N, Vignes K, Srinivasan A, Cockerham C, Bauer JA, O’Brien JM. Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension. Biomedicines 2023; 11:2954. [PMID: 38001956 PMCID: PMC10669350 DOI: 10.3390/biomedicines11112954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Emerging evidence indicates a previously unrecognized, clinically relevant spectrum of abnormal aldosterone secretion associated with hypertension severity. It is not known whether excess aldosterone secretion contributes to hypertension during pregnancy. We quantified aldosterone concentrations and angiotensin peptides in serum (using liquid chromatography with tandem mass spectrometry) in a cohort of 128 pregnant women recruited from a high-risk obstetrics clinic and followed prospectively for the development of gestational hypertension, pre-eclampsia, superimposed pre-eclampsia, chronic hypertension, or remaining normotensive. The cohort was grouped by quartile of aldosterone concentration in serum measured in the first trimester, and blood pressure, angiotensin peptides, and hypertension outcomes compared across the four quartiles. Blood pressures and body mass index were greatest in the top and bottom quartiles, with the top quartile having the highest blood pressure throughout pregnancy. Further stratification of the top quartile based on increasing (13 patients) or decreasing (19 patients) renin activity over gestation revealed that the latter group was characterized by the highest prevalence of chronic hypertension, use of anti-hypertensive agents, pre-term birth, and intrauterine growth restriction. Serum aldosterone concentrations greater than 704 pmol/L, the 75th percentile defined within the cohort, were evident across all categories of hypertension in pregnancy, including normotensive. These findings suggest that aldosterone excess may underlie the development of hypertension in pregnancy in a significant subpopulation of individuals.
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Affiliation(s)
- Robin Shoemaker
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA
| | | | - Dolph Davis
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA
| | - Hong Huang
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - Aric Schadler
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - Neil Patel
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Katherine Vignes
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Aarthi Srinivasan
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - Cynthia Cockerham
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
| | - John A. Bauer
- Department of Pediatrics, University of Kentucky, Lexington, KY 40536, USA
| | - John M. O’Brien
- Department of Obstetrics and Gynecology, University of Kentucky, Lexington, KY 40536, USA
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9
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Iwamoto Y, Kimura T, Ohnishi M, Kusano T, Takenouchi H, Iwamoto H, Sanada J, Fushimi Y, Katakura Y, Tatsumi F, Shimoda M, Nakanishi S, Kaku K, Mune T, Kaneto H. Simple standing test without furosemide is useful in the diagnosis of primary aldosteronism. Sci Rep 2023; 13:13381. [PMID: 37591913 PMCID: PMC10435472 DOI: 10.1038/s41598-023-40574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023] Open
Abstract
Primary aldosteronism (PA) is a well-known cause of secondary hypertension. We have long performed the simple standing test in patients with PA. On the other hand, there are few reports on the usefulness of the simple standing test in PA. This study is a single-center, retrospective, observational study. A total of 173 patients with hypertension or adrenal tumor admitted to Kawasaki Medical School were included. Eighty patients who met the exclusion criteria were excluded, and 31 patients without PA (non-PA), 26 patients with unilateral PA, and 36 patients with bilateral PA were included in the study. The simple standing test was performed after 120 min of standing or sitting followed, and the aldosterone/renin ratio (ARR) and percentage of increase plasma aldosterone concentration (%increase of PAC) was calculated. The mean ARR in the simple standing test in unilateral PA (1143 (528-2200)) and bilateral PA subjects (521 (374-765)) were significantly higher compared to non-PA subjects (152 (102-240)) (p < 0.0001, p = 0.0013, respectively). The percentage increase of PAC after standing loading was significantly lower in unilateral PA subjects (110 (96-140)) compared to non-PA subjects (187 (155-244)) (p = 0.0003), with no difference between non-PA and bilateral PA subjects (p = 0.99). The cutoff value of the ARR in the simple standing test for diagnosis of PA in this study was 364 (AUC = 0.948, sensitivity = 83.8%, specificity = 93.5%, false positive rate = 3.7%, false negative rate = 25.6%, p < 0.001), which was not inferior to the diagnostic performance of the captopril loading test. The diagnostic performance of the simple standing test for PA was not inferior to that of the captopril loading test. The percentage increase of PAC in unilateral PA subjects was significantly lower compared to bilateral PA subjects. These results demonstrate the usefulness of the simple standing test, which can be performed simultaneously with general screening tests of PA.
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Affiliation(s)
- Yuichiro Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Tomohiko Kimura
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Mana Ohnishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Takashi Kusano
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Haruka Takenouchi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Hideyuki Iwamoto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Junpei Sanada
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yoshiro Fushimi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Yukino Katakura
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Fuminori Tatsumi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Masashi Shimoda
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Shuhei Nakanishi
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Kohei Kaku
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Tomoatsu Mune
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Hideaki Kaneto
- Division of Diabetes, Metabolism and Endocrinology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
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10
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Cuthbertson DJ, Alam U, Davison AS, Belfield J, Shore SL, Vinjamuri S. Investigation and assessment of adrenal incidentalomas. Clin Med (Lond) 2023; 23:135-140. [PMID: 36958837 PMCID: PMC11046519 DOI: 10.7861/clinmed.2023-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
With the increasing volume of diagnostic imaging undertaken in an ageing population, adrenal incidentalomas (AIs) are increasingly commonly seen. These masses are most likely to be benign, but a small proportion may be malignant. Similarly, they are usually non-functional, but ∼14% are functional, ie hormone-secreting tumours. Clinical, biochemical and radiological assessment is mandated to stratify patients into those requiring radiological surveillance, medical management or surgical intervention or who can be discharged. Mass characteristics on cross-sectional (CT/MRI) imaging influence the need for radiological surveillance. Functional tumours where excess cortisol, aldosterone or catecholamine are secreted should be excluded, with mild autonomous cortisol secretion (MACS) and primary aldosteronism (PA) as the two most common functional states. MACS and PA are associated with an increased risk of cardiometabolic disease (eg hypertension, type 2 diabetes) and cardiovascular morbidity/mortality (eg coronary heart disease). Multidisciplinary management is critical for selected cases; the majority of adrenal incidentalomas only require a single assessment.
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Affiliation(s)
- Daniel J Cuthbertson
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK and professor of medicine, University of Liverpool, Liverpool, UK
| | - Uazman Alam
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK and senior clinical lecturer in medicine, University of Liverpool, Liverpool, UK
| | - Andrew S Davison
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jane Belfield
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Susannah L Shore
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sobhan Vinjamuri
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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11
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Parasiliti-Caprino M, Ghigo E, Maccario M. Primary aldosteronism is a clinical issue that should not be underestimated anymore. J Endocrinol Invest 2022; 46:639-640. [PMID: 36472776 DOI: 10.1007/s40618-022-01981-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- M Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - E Ghigo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Maccario
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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