Primary Aldosteronism: Novel Insights | Bentham Science
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Current Hypertension Reviews

Editor-in-Chief

ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

Review Article

Primary Aldosteronism: Novel Insights

Author(s): Konstantinos Stavropoulos, Konstantinos Imprialos, Vasilios Papademetriou, Charles Faselis, Kostas Tsioufis, Kyriakos Dimitriadis and Michael Doumas*

Volume 16, Issue 1, 2020

Page: [19 - 23] Pages: 5

DOI: 10.2174/1573402115666190415155512

Open Access Journals Promotions 2
Abstract

Background: Primary aldosteronism is one of the most common causes of secondary hypertension. Patients with this endocrine syndrome are at increased cardiovascular risk, higher than hypertensive individuals with equal blood pressure levels.

Objectives: The study aimed to thoroughly present and critically discuss the novel insights into the field of primary aldosteronism, focusing on the clinically meaningful aspects.

Method: We meticulously evaluated existing data in the field of primary aldosteronism in order to summarize future perspectives in this narrative review.

Results: Novel data suggests that a subclinical form of primary aldosteronism might exist. Interesting findings might simplify the diagnostic procedure of the disease, especially for the localization of primary aldosteronism. The most promising progress has been noted in the field of the molecular basis of the disease, suggesting new potential therapeutic targets.

Conclusion: Several significant aspects are at early stages of evaluation. Future research is essential to investigate these well-promising perspectives.

Keywords: Primary aldosteronism, arterial hypertension, secondary hypertension, cardiovascular disease, subclinical aldosteronism, CXCR4 PET scan, KCNJ5 mutations, SIAH1.

Graphical Abstract
[1]
Faselis C, Doumas M, Papademetriou V. Common secondary causes of resistant hypertension and rational for treatment. Int J Hypertens 2011; 2011: 236239
[2]
Conn JW, Part I. Painting background. Part II. Primary aldosteronism, a new clinical syndrome. J Lab Clin Med 1955; 45: 3-17.
[3]
Mulatero P, Stowasser M, Loh KC, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 2004; 89: 1045-50.
[4]
Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: Case detection, diagnosis, and treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2016; 101: 1889-916.
[5]
Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 2006; 48: 2293-300.
[6]
Douma S, Petidis K, Doumas M, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: A retrospective observational study. Lancet 2008; 371: 1921-6.
[7]
Maiolino G, Rossitto G, Bisogni V, et al. Quantitative value of aldosterone-renin ratio for detection of aldosterone-producing adenoma: The Aldosterone-Renin Ratio for Primary Aldosteronism (AQUARR) study. J Am Heart Assoc 2017; 6(: pii: )e005574
[8]
Monticone S, Burrello J, Tizzani D, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in Primary Care Practice. J Am Coll Cardiol 2017; 69: 1811-20.
[9]
Käyser SC, Dekkers T, Groenewoud HJ, et al. Study heterogeneity and estimation of prevalence of primary aldosteronism: A systematic review and meta-regression analysis. J Clin Endocrinol Metab 2016; 101: 2826-35.
[10]
Funder JW. Aldosterone and mineralocorticoid receptors-physiology and pathophysiology. Int J Mol Sci 2017; 18 : pii: E1032
[11]
Doumas M, Douma S. Primary aldosteronism: A field on the move.In: Tsioufis C, Schmieder R, Mancia G, eds. . Interventional Therapies for Secondary and Essential Hypertension, Updates in Hypertension and Cardiovascular Protection. Cham, Switzerland: Springer International Publishing 2016; pp. 26-55.
[12]
Savard S, Amar L, Plouin PF, et al. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 2013; 62: 331-6.
[13]
Monticone S, D’Ascenzo F, Moretti C, et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2018; 6: 41-50.
[14]
Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36: 1953-2041.
[15]
Karagiannis A. Treatment of primary aldosteronism: Where are we now? Rev Endocr Metab Disord 2011; 12: 15-20.
[16]
Stavropoulos K, Imprialos KP, Doumas M, et al. Subclinical target organ damage in primary aldosteronism: Resistant to spironolactone therapy? J Hypertens 2018; 36: 701.
[17]
Karagiannis A, Tziomalos K, Kakafika AI, et al. Medical treatment as an alternative to adrenalectomy in patients with aldosterone-producing adenomas. Endocr Relat Cancer 2008; 15: 693-700.
[18]
Williams TA, Lenders JWM, Mulatero P, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: An international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Endocrinol 2017; 5: 689-99.
[19]
Ito Y, Takeda R, Karashima S, et al. Prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects. Hypertens Res 2011; 34: 98-102.
[20]
Rossi GP. Does primary aldosteronism exist in normotensive and mildly hypertensive patients, and should we look for it? Hypertens Res 2011; 34: 43-6.
[21]
Stavropoulos K, Papadopoulos C, Koutsampasopoulos K, et al. Mineralocorticoid receptor antagonists in the management of primary aldosteronism. Curr Pharm Des 2019. [Epub ahead of print].
[http://dx.doi.org/10.2174/1381612825666190311130138]
[22]
Brown JM, Robinson-Cohen C, Luque-Fernandez MA, et al. The spectrum of subclinical primary aldosteronism and incident hypertension: A cohort study. Ann Intern Med 2017; 167: 630-41.
[23]
Fassnacht M, Arlt W, Bancos I, et al. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2016; 175: G1-G34.
[24]
Stavropoulos K, Imprialos KP, Doumas M. Bypass of confirmatory tests for case detection of primary aldosteronism in leaner patients? J Clin Hypertens (Greenwich) 2017; 19: 798-800.
[25]
Wolley MJ, Stowasser M. New advances in the diagnostic workup of primary aldosteronism. J Endocr Soc 2017; 1: 149-61.
[26]
Doumas M, Athyros V, Papademetriou V. Screening for primary aldosteronism: Whom and how? J Clin Hypertens (Greenwich) 2015; 17: 547-8.
[27]
Stavropoulos K, Imprialos KP, Katsiki N, et al. Primary aldosteronism in patients with adrenal incidentaloma: Is screening appropriate for everyone? J Clin Hypertens (Greenwich) 2018; 20: 942-8.
[28]
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71: e127-248.
[29]
Tirosh A, Hannah-Shmouni F, Lyssikatos C, et al. Obesity and the diagnostic accuracy for primary aldosteronism. J Clin Hypertens (Greenwich) 2017; 19: 790-7.
[30]
Rye P, So B, Harvey A, et al. Unadjusted plasma renin activity as a ‘first look’ test to decide upon further investigations for primary aldosteronism. J Clin Hypertens (Greenwich) 2015; 17: 541-6.
[31]
Ahmed AH, Cowley D, Wolley M, et al. Seated saline suppression testing for the diagnosis of primary aldosteronism: A preliminary study. J Clin Endocrinol Metab 2014; 99: 2745-53.
[32]
Funder JW. Primary aldosteronism: New answers, new questions. Horm Metab Res 2015; 47: 935-40.
[33]
Gouli A, Kaltsas G, Tzonou A, et al. High prevalence of autonomous aldosterone secretion among patients with essential hypertension. Eur J Clin Invest 2011; 41: 1227-36.
[34]
Markou A, Sertedak A, Kaltsas G, et al. Stress-induced aldosterone hypersecretion in a substantial subset of patients with essential hypertension. J Clin Endocrinol Metab 2015; 100: 2857-64.
[35]
Rossi GD, Auchus RJ, Brown M, et al. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension 2014; 63: 151-60.
[36]
Rossi GP, Funder JW. Adrenal vein sampling is the preferred method to select patients with primary aldosteronism for adrenalectomy: Pro side of the argument. Hypertension 2018; 71: 5-9.
[37]
Rossi GP. Update in adrenal venous sampling for primary aldosteronism. Curr Opin Endocrinol Diabetes Obes 2018; 25: 160-71.
[38]
Young WF, Stanson AW, Thompson GB, et al. Role for adrenal venous sampling in ptimary aldosteronism. Surgery 2004; 136: 1227-35.
[39]
Patel SM, Lingam RK, Beaconsfield TI, et al. Role of radiology in the management of primary aldosteronism. Radiographics 2007; 27: 1145-57.
[40]
Kempers MJ, Lenders JW, van Outheusden L, et al. Systematic review: Diagnostic procedure to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 2009; 151: 329-37.
[41]
Raman SP, Lessne M, Kawamoto S, et al. Diagnostic performance of multidetector computed tomography in distinguishing unilateral from bilateral abnormalities in primary hyperaldosteronism: comparison of multidetector computed tomography with adrenal vein sampling. J Comput Assist Tomogr 2015; 39: 414-8.
[42]
Deinum J, Prejbisz A, Lenders JWM, et al. Adrenal vein sampling is the preferred method to select patients with primary aldosteronism for adrenalectomy: Con side of the argument. Hypertension 2018; 71: 10-4.
[43]
Williams TA, Burrello J, Sechi LA, et al. Computed tomography and adrenal venous sampling in the diagnosis of unilateral primary aldosteronism. Hypertension 2018; 72: 641-9.
[44]
Riester A, Fischer E, Degenhart C, et al. Age below 40 or a recently proposed clinical prediction score cannot bypass adrenal venous sampling in primary aldosteronism. J Clin Endocrinol Metab 2014; 99: E1035-9.
[45]
Mulatero P, Bertello C, Rossato D, et al. Roles of clinical criteria, computed tomography scan, and adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes. J Clin Endocrinol Metab 2008; 93: 1366-71.
[46]
Venos ES, So B, Dias VC, et al. A clinical prediction score for diagnosing unilateral primary aldosteronism may not be generalizable. BMC Endocr Disord 2014; 14: 94.
[47]
Sze WC, Soh LM, Lau JH, et al. Diagnosing unilateral primary aldosteronism - comparison of a clinical prediction score, computed tomography and adrenal venous sampling. Clin Endocrinol (Oxf) 2014; 81: 25-30.
[48]
Küpers EM, Amar L, Raynaud A, et al. A clinical prediction score to diagnose unilateral primary aldosteronism. J Clin Endocrinol Metab 2012; 97: 3530-7.
[49]
Abe T, Naruse M, Young WF Jr, et al. A novel CYP11B2-specific imaging agent for detection of unilateral subtypes of primary aldosteronism. J Clin Endocrinol Metab 2016; 101: 1008-15.
[50]
Heinze B, Fuss CT, Mulatero P, et al. Targeting CXCR4 (CXC Chemokine Receptor Type 4) for molecular imaging of aldosterone-producing adenoma. Hypertension 2018; 71: 317-25.
[51]
Prada ETA, Burrello J, Reincke M, et al. Old and new concepts in the molecular pathogenesis of primary aldosteronism. Hypertension 2018; 70: 875-81.
[52]
Mulatero P, Monticone S, Rainey WE, et al. Role of KCNJ5 in familial and sporadic primary aldosteronism. Nat Rev Endocrinol 2013; 9: 104-12.
[53]
Scholl UI, Abriola L, Zhang C, et al. Macrolides selectively inhibit mutant KCNJ5 potassium channels that cause aldosterone-producing adenoma. J Clin Invest 2017; 127: 2739-50.
[54]
Caroccia B, Prisco S, Seccia TM, et al. Macrolides blunt aldosterone biosynthesis: a proof-of-concept study in KCNJ5 mutated adenoma cells ex vivo. Hypertension 2017; 70: 1238-42.
[55]
Maiolino G, Ceolotto G, Battistel M, et al. Macrolides for KCNJ5-mutated aldosterone-producing adenoma (MAPA): Design of a study for personalized diagnosis of primary aldosteronism. Blood Press 2018; 27: 200-5.
[56]
Scortegagna M, Berthon A, Settas N, et al. The E3 ubiquitin ligase Siah1 regulates adrenal gland organization and aldosterone secretion. JCI Insight 2017; 2(pii: ): 97128.

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