, Volume 63, Issue 3, pp 470–475 | Cite as

Larger ascending aorta in primary aldosteronism: a 3-year prospective evaluation of adrenalectomy vs. medical treatment

  • Guido Zavatta
  • Guido Di Dalmazi
  • Carmine Pizzi
  • Giovanni Bracchetti
  • Cristina Mosconi
  • Caterina Balacchi
  • Uberto Pagotto
  • Valentina VicennatiEmail author
Endocrine Surgery



Primary aldosteronism is associated with higher cardiovascular morbidity as compared with essential hypertension. Vascular complications encompass myocardial infarction and cerebrovascular events. Aortic damage in primary aldosteronism has never been explored, although a few cases of ascending aorta aneurisms have been reported.

Design and methods

We consecutively enrolled patients affected by primary aldosteronism (n = 45) and compared them with patients affected by essential hypertension (n = 47), on an outpatient setting. Echocardiographic data of patients with primary aldosteronism were collected during a mean follow-up of 3 years, in subjects who underwent adrenal surgery (n = 12) and those on mineralocorticoid receptor antagonists (n = 33).

Results and conclusion

We found that patients with primary aldosteronism had larger ascending aorta diameters than those with essential hypertension before starting any specific treatment. Patients with primary aldosteronism did not show significant changes in the size of ascending aorta during a mean of 3 years of follow-up, irrespective of the type of treatment (medical vs. surgical treatment). A longer follow-up will better clarify if worsening of the aortic damage may be better prevented by surgery rather than by mineralocorticoid receptor antagonists.


Primary aldosteronism Ascending aorta Aortic root Aortic aneurysm Aldosterone Adrenal cortex 



primary aldosteronism


hypertensive control patients with nonsecreting adrenal adenoma


body-surface-area (m2)


transthoracic echocardiogram


computed tomography


captopril-challenge test




mineralocorticoid receptor


blood pressure


tubular ascending


essential hypertension


left ventricular hypertrophy




This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Author contributions

The authors equally contributed in writing the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    G.P. Rossi, A. Dalla Cà, Clinical management of primary aldosteronism. High Blood Press Cardiovasc Prev. 21(1), 71–75 (2014). CrossRefGoogle Scholar
  2. 2.
    W.F. Young, Minireview: primary aldosteronism—changing concepts in diagnosis and treatment. Endocrinology 144(6), 2208–2213 (2003). CrossRefGoogle Scholar
  3. 3.
    C. Catena, G. Colussi, E. Nadalini, A. Chiuch, S. Baroselli, R. Lapenna, L.A. Sechi, Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch. Intern. Med. 168, 80–85 (2008)CrossRefGoogle Scholar
  4. 4.
    S. Savard, L. Amar, P.-F. Plouin, O. Steichen, Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 62(2), 331–336 (2013 Aug)CrossRefGoogle Scholar
  5. 5.
    G.-P. Rossi, L.A. Sechi, G. Giacchetti, V. Ronconi, P. Strazzullo, J.W. Funder, Primary aldosteronism: cardiovascular, renal and metabolic implications. Trends Endocrinol. Metab. 19(3), 88–90 (2008 Apr)CrossRefGoogle Scholar
  6. 6.
    S. Monticone, F. D’Ascenzo, C. Moretti et al. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 6(1), 41–50 (2018). CrossRefGoogle Scholar
  7. 7.
    G.P. Rossi, G. Bernini, G. Desideri, B. Fabris, C. Ferri, G. Giacchetti, C. Letizia, M. Maccario, M. Mannelli, M. Matterello, D. Montemurro, G. Palumbo, D. Rizzoni, E. Rossi, A.C. Pessina, F. Mantero, Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 48(2), 232–238 (2006)CrossRefGoogle Scholar
  8. 8.
    L.A. Sechi, M. Novello, R. Lapenna, S. Baroselli, E. Nadalini, G.L. Colussi, C. Catena, Long-term renal outcomes in patients with primary aldosteronism. J Am Med Assoc 295, 2638–2645 (2006)CrossRefGoogle Scholar
  9. 9.
    M. Reincke, E. Fischer, S. Gerum, K. Merkle, S. Schulz, A. Pallauf, M. Quinkler, G. Hanslik, K. Lang, S. Hahner, B. Allolio, C. Meisinger, R. Holle, F. Beuschlein, M. Bidlingmaier, S. Endres, Observational study mortality in treated primary aldosteronism: the German Conn’s registry. Hypertension 60(3), 618–624 (2012)CrossRefGoogle Scholar
  10. 10.
    A. Tanabe, M. Naruse, K. Naruse, M. Hase, T. Yoshimoto, M. Tanaka, T. Seki, R. Demura, H. Demura, Left ventricular hypertrophy is more prominent in patients with primary aldosteronism than in patients with other types of secondary hypertension. Hypertens. Res. 20, 85–90 (1997)CrossRefGoogle Scholar
  11. 11.
    M. Abad-Cardiel, B. Alvarez-Álvarez, L. Luque-Fernandez, C. Fernández, A. Fernández-Cruz, N. Martell-Claros, Hypertension caused by primary hyperaldosteronism: increased heart damage and cardiovascular risk. Rev. Esp. Cardiol. 66, 47–52 (2013)CrossRefGoogle Scholar
  12. 12.
    B. Pitt, F. Zannad, W.J. Remme, R. Cody, A. Castaigne, A. Perez, J. Palensky, J. Wittes, The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N. Engl. J. Med. 341(10), 709–717 (1999)CrossRefGoogle Scholar
  13. 13.
    B. Pitt, W. Remme, F. Zannad, J. Neaton, F. Martinez, B. Roniker, R. Bittman, S. Hurley, J. Kleiman, M. Gatlin, Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N. Engl. J. Med. 348(14), 1309–1321 (2003)CrossRefGoogle Scholar
  14. 14.
    M.F. Neves, F. Amiri, A. Virdis, Q.N. Diep, E.L. Schiffrin, Role of aldosterone in angiotensin II-induced cardiac and aortic inflammation, fibrosis, and hypertrophy. Can. J. Physiol. Pharmacol. 83(11), 999–1006 (2005)CrossRefGoogle Scholar
  15. 15.
    A.M. Marney, N.J. Brown, Aldosterone and end-organ damage. Clin. Sci. (Lond.) 113, 267–278 (2007)CrossRefGoogle Scholar
  16. 16.
    J. Widimsky Jr., B. Strauch, O. Petrák, J. Rosa, Z. Somloova, T. Zelinka, R. Holaj. Vascular disturbances in primary aldosteronism: clinical evidence. Kidney Blood Press. Res. 529–533 (2012).
  17. 17.
    N. López Andrés, A. Tesse, V. Regnault, H. Louis, V. Cattan, S.N. Thornton, C. Labat, A. Kakou, S. Tual-Chalot, S. Faure, P. Challande, M. Osborne-Pellegrin, M.C. Martinez, P. Lacolley, R. Andriantsitohaina, Increased microparticle production and impaired microvascular endothelial function in aldosterone-salt-treated rats: protective effects of polyphenols. PLoS One 7(7), e39235 (2012)CrossRefGoogle Scholar
  18. 18.
    Y. Yan, J. Ouyang, C. Wang, Z. Wu, X. Ma, H. Li, H. Xu, Z. Hu, J. Li, B. Wang, T. Shi, D. Gong, D. Ni, X. Zhang, Aortic cell apoptosis in rat primary aldosteronism model.J. Huazhong Univ. Sci. Technol. [Med. Sci.] 30, 385–390 (2010). CrossRefGoogle Scholar
  19. 19.
    S. Liu, Z. Xie, A. Daugherty, L.A. Cassis, K.J. Pearson, M.C. Gong, Z. Guo, Mineralocorticoid receptor agonists induce mouse aortic aneurysm formation and rupture in the presence of high salt. Arterioscler. Thromb. Vasc. Biol. 33(7), 1568–1579 (2013)CrossRefGoogle Scholar
  20. 20.
    S.H. Ahmed, N.M. Husain, S.N. Khawaja, C.V. Massey, F.S. Pettyjohn, Is primary hyperaldosteronism a risk factor for aortic dissection? Cardiology 108(1), 48–50 (2007)CrossRefGoogle Scholar
  21. 21.
    M. Podgórski, A. Derkacz, R. Poręba, K. Belowska-Bień, K. Gruber, A. Szuba, R. Andrzejak, Aortic dissection—a rare complication of primary aldosteronism—a case report. Kardiol. Pol. 69(2), 156–158 (2011). discussion 159Google Scholar
  22. 22.
    K.-Y. Lam, C.-Y. Lo, The clinicopathologic significance of unilateral adrenal cortical hyperplasia: report of an unusual case and a review of the literature. Endocr. Pathol. 10(3), 243–249 (1999)CrossRefGoogle Scholar
  23. 23.
    Y. Ito, K. Yoshimura, Y. Matsuzawa, J. Saito, H. Ito, H. Furukawa, K. Okura, M. Fukata, T. Konishi, T. Nishikawa, Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone. J. Atheroscler. Thromb. 17, 771–775 (2010). [cited 13 November 2014]CrossRefGoogle Scholar
  24. 24.
    R.M. Lang, M. Bierig, R.B. Devereux, F.A. Flachskampf, E. Foster, P.A. Pellikka, M.H. Picard, M.J. Roman, J. Seward, J.S. Shanewise, Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J. Am. Soc. Echocardiogr. 18, 1440–1463 (2005)CrossRefGoogle Scholar
  25. 25.
    A. Evangelista, Fa Flachskampf, R. Erbel, F. Antonini-Canterin, C. Vlachopoulos, G. Rocchi, R. Sicari, P. Nihoyannopoulos, J. Zamorano, Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur. J. Echocardiogr. 11(8), 645–658 (2010)CrossRefGoogle Scholar
  26. 26.
    R.S. Vasan, M.G. Larson, D. Levy, Determinants of echocardiographic aortic root size. The Framingham Heart Study. Circulation 91(3), 734–740 (1995)CrossRefGoogle Scholar
  27. 27.
    R.S. Vasan, M.G. Larson, E.J. Benjamin, D. Levy, The echocardiographic reference values for aortic root size: the Framingham Heart Study. J. Am. Soc. Echocardiogr. 8(6), 793–800 (1995). Boston, Massachusetts, and Bethesda MCrossRefGoogle Scholar
  28. 28.
    V. Palmieri, J.N. Bella, D.K. Arnett, M.J. Roman, A. Oberman, D.W. Kitzman, P.N. Hopkins, M. Paranicas, D.C. Rao, R.B. Devereux, Aortic root dilatation at sinuses of valsalva and aortic regurgitation in hypertensive and normotensive subjects: the Hypertension Genetic Epidemiology Network Study. Hypertension 37(5), 1229–1235 (2001)CrossRefGoogle Scholar
  29. 29.
    Erbel R., Eggebrecht H. Aortic dimensions and the risk of dissection. Heart. (2006)
  30. 30.
    J.W. Funder, R.M. Carey, C. Fardella, C.E. Gomez-Sanchez, F. Mantero, M. Stowasser, J.W.F. Young, V.M. Montori, Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 93(9), 3266–3281 (2008)CrossRefGoogle Scholar
  31. 31.
    G. Di Dalmazi, V. Vicennati, E. Rinaldi, A.M. Morselli-Labate, E. Giampalma, C. Mosconi, U. Pagotto, R. Pasquali, Progressively increased patterns of subclinical cortisol hypersecretion in adrenal incidentalomas differently predict major metabolic and cardiovascular outcomes: a large cross-sectional study. Eur. J. Endocrinol. 166(4), 669–677 (2012)CrossRefGoogle Scholar
  32. 32.
    L.K. Nieman, B.M.K. Biller, J.W. Findling, J. Newell-Price, M.O. Savage, P.M. Stewart, V.M. Montori, The diagnosis of Cushing’s syndrome: an Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. Endocr. Soc. 93(5), 1526–1540 (2008)CrossRefGoogle Scholar
  33. 33.
    R. Holaj, T. Zelinka, D. Wichterle, O. Petrák, B. Strauch, J. Widimský, Increased intima-media thickness of the common carotid artery in primary aldosteronism in comparison with essential hypertension. J. Hypertens. 25(7), 1451–1457 (2007)CrossRefGoogle Scholar
  34. 34.
    V. Cachofeiro, M. Miana, N. de Las Heras, B. Martín-Fernández, S. Ballesteros, J. Fernández-Tresguerres, V. Lahera, Aldosterone and the vascular system. J. Steroid Biochem. Mol. Biol. 109(3–5), 331–335 (2008). [cited 28 April 2014]CrossRefGoogle Scholar
  35. 35.
    G. Mancia, R. Fagard, K. Narkiewicz, J. Redon, A. Zanchetti, M. Böhm, T. Christiaens, R. Cifkova, G. De Backer, A. Dominiczak, M.E. Galderisi, D. Grobbee, T. Jaarsma, P.E. Kirchhof, S. Kjeldsen, S.J. Laurent, A.M. Manolis, P. Nilsson, L.M. Ruilope, R. E. Schmieder, P.A. Sirnes, P. Sleight, M. Viigima, B. Waeber, F. Zannad, 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur. Heart J. 34(28), 2159–2219 (2013)CrossRefGoogle Scholar
  36. 36.
    S. Buckvold, A.T. Yetman, L.F. Hiratzka, G.L. Bakris, J.A. Beckman, R.M. Bersin et al.. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, A. Circulation 121, e266–e369 (2010)Google Scholar
  37. 37.
    H. Hirai, T. Shibata, Y. Sasaki, H. Fujii, S. Kubo, S. Suehiro, Simultaneous surgery for chronic aortic dissection and adrenal adenoma with primary aldosteronism. Gen. Thorac. Cardiovasc. Surg. 58(5), 235–237 (2010). discussion 238CrossRefGoogle Scholar
  38. 38.
    M. Arshad, A.M. Safi, T. Kwan, E. Afflu, M. Alam, J.E. Anderson, L. T. Clark, Coronary artery aneurysms, aortic dissection, and hypertension secondary to primary aldosteronism: a rare triad. A case report. Angiology 50(6), 503–508 (1999)CrossRefGoogle Scholar
  39. 39.
    J.-M. Tartière, L. Kesri, J.-J. Mourad, M. Safar, J. Blacher, Primary aldosteronism. A risk factor for aortic dissection? J. Mal. Vasc. 28(4), 185–189 (2003)Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Guido Zavatta
    • 1
  • Guido Di Dalmazi
    • 1
  • Carmine Pizzi
    • 2
  • Giovanni Bracchetti
    • 2
  • Cristina Mosconi
    • 3
  • Caterina Balacchi
    • 3
  • Uberto Pagotto
    • 1
  • Valentina Vicennati
    • 1
    Email author
  1. 1.Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi HospitalAlma Mater Studiorium-University of BolognaBolognaItaly
  2. 2.Institute of Cardiology, S. Orsola-Malpighi HospitalBolognaItaly
  3. 3.Division of Radiology, S. Orsola-Malpighi HospitalBolognaItaly

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