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Primary Aldosteronism: A Field on the Move

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Interventional Therapies for Secondary and Essential Hypertension

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

Abstract

Primary aldosteronism is the most common form of secondary hypertension, and is highly prevalent in patients with resistant hypertension. The diagnosis of primary aldosteronism in real life is time consuming and might be tricky. The screening for primary aldosteronism (whom to screen and how to screen), the confirmation of the diagnosis (four tests are currently used), and the lateralization of the disease (three tests available) remain a topic of vivid discussion. Therefore, diagnostic and therapeutic algorithms are perplexed and difficult to be implemented in everyday clinical practice. The aim of this chapter is to provide the basis for detecting primary aldosteronism in resistant hypertension in the interventional era; to summarize the magnitude of the problem; to critically discuss available tests for the screening, confirmation, and lateralization of primary aldosteronism; to present the therapeutic options; and to propose a simple algorithm for the diagnosis and management of primary aldosteronism.

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Abbreviations

ARR:

Aldosterone-renin ratio

CT:

Computed tomography

dRHTN:

Drug-resistant hypertension

HTN:

Hypertension

MRI:

Magnetic resonance imaging

References

  1. Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension. J Hypertens 31:1281–1357

    Article  CAS  PubMed  Google Scholar 

  2. Faselis C, Doumas M, Papademetriou V (2011) Common secondary causes of resistant hypertension and rational for treatment. Int J Hypertens 2011:236239

    Article  PubMed  PubMed Central  Google Scholar 

  3. Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissman P (2002) High prevalence of primary aldosteronism among black and white subjects with resistant hypertension. Hypertension 40:892–896

    Article  CAS  PubMed  Google Scholar 

  4. Eide IK, Torjesen PA, Drolsum A, Babovic A, Lilledahl NP (2004) Low-renin status in therapy-resistant hypertension: a clue to efficient treatment. J Hypertens 22:2217–2226

    Article  CAS  PubMed  Google Scholar 

  5. Martell N, Rodriguez-Cerrillo M, Grobee DE, Lopez-Eady MD, Fernandez-Pinilla C, Avila M, Fernandez-Cruz A, Luque M (2003) High prevalence of secondary hypertension and insulin resistance in patients with refractory hypertension. Blood Press 12:149–154

    Article  CAS  PubMed  Google Scholar 

  6. Umpierrez GE, Cantey P, Smiley D, Palacio A, Temponi D, Luster K, Chapman A (2007) Primary aldosteronism in diabetic subjects with resistant hypertension. Diabetes Care 30:1699–1703

    Article  CAS  PubMed  Google Scholar 

  7. Douma S, Petidis K, Doumas M et al (2008) Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet 371:1921–1926

    Article  CAS  PubMed  Google Scholar 

  8. Florczak E, Prejbisz A, Szwench-Pietrasz E, Sliwinski P, Bielen P, Klisiewicz A, Michalowska I, Warchol E, Januszewicz M, Kala M, Witkowski A, Wiecek A, Narkiewicz K, Somers VK, Januszewicz A (2013) Clinical characteristics of patients with resistant hypertension: the RESIST-POL study. J Hum Hypertens 27:678–685

    Article  CAS  PubMed  Google Scholar 

  9. Papademetriou V, Tsioufis C, Doumas M (2014) Renal denervation and Symplicity HTN-3: “Dubium sapientiae initium” (doubt is the beginning of wisdom). Circ Res 115:211–214

    Article  CAS  PubMed  Google Scholar 

  10. Papademetriou V, Rashidi AA, Tsioufis C, Doumas M (2014) Renal nerve ablation for resistant hypertension: how did we get here, present status and future directions. Circulation 129:1440–1451

    Article  PubMed  Google Scholar 

  11. Doumas M, Faselis C, Papademetriou V (2011) Renal sympathetic denervation in hypertension. Curr Opin Nephrol Hypertens 20:647–653

    Article  PubMed  Google Scholar 

  12. Doumas M, Faselis C, Kokkinos P et al (2014) Carotid baroreceptor stimulation: a promising approach for the management of resistant hypertension and heart failure. Curr Vasc Pharmacol 12:30–37

    Article  CAS  PubMed  Google Scholar 

  13. Doumas M, Faselis C, Tsioufis C, Papademetriou V (2012) Carotid baroreceptor activation for the treatment of resistant hypertension and heart failure. Curr Hypertens Rep 14:238–246

    Article  CAS  PubMed  Google Scholar 

  14. Doumas M, Athyros V, Papademetriou V (2015) Screening for primary aldosteronism: whom and how? J Clin Hypertens 17:547–548

    Article  Google Scholar 

  15. Douma S, Petidis K, Kamparoudis A et al (2012) Surgical management of primary aldosteronism: not everything that shines is gold. Clin Exp Hypertens 34:53–56

    Article  CAS  PubMed  Google Scholar 

  16. Sarafidis PA, Bakris GL (2008) Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol 52:1749–1757

    Article  PubMed  Google Scholar 

  17. Calhoun DA, Jones D, Textor S et al (2008) Resistant hypertension: diagnosis, evaluation, and treatment. Circulation 117:e510–e526

    Article  PubMed  Google Scholar 

  18. Krum H, Schlaich M, Whitbourn R et al (2009) Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet 373:1275–1281

    Article  PubMed  Google Scholar 

  19. Symplicity HTN-2 Investigators, Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohm M (2010) Renal sympathetic denervation in patients with treatment-resistant hypertension (the Symplicity HTN-2 trial): a randomised controlled trial. Lancet 376:1903–1909

    Article  Google Scholar 

  20. Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL, Symplicity HTN-3 Investigators (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370:1393–1401

    Article  CAS  PubMed  Google Scholar 

  21. Bisognano JD, Bakris G, Nadim MK et al (2011) Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol 58:765–773

    Article  PubMed  Google Scholar 

  22. Nishizaka MK, Zaman MA, Calhoun DA (2003) Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am J Hypertens 16:925–930

    Article  CAS  PubMed  Google Scholar 

  23. Conn JW (1955) Primary aldosteronism: a new clinical syndrome. J Lab Clin Med 45:3–17

    CAS  PubMed  Google Scholar 

  24. Andersen GS, Toftdahl DB, Lund JO et al (1988) The incidence rate of phaeochromocytoma and Conn’s syndrome in Denmark, 1977–1981. J Hum Hypertens 2:187–189

    CAS  PubMed  Google Scholar 

  25. Berglund G, Andersson O, Wilhelmsen L (1976) Prevalence of primary and secondary hypertension: studies in a random population sample. Br Med J 2:554–556

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Kaplan NM (1967) Hypokalemia in the hypertensive patient, with observations on the incidence of primary aldosteronism. Ann Intern Med 66:1079–1090

    Article  CAS  PubMed  Google Scholar 

  27. Sinclair AM, Isles CG, Brown I et al (1987) Secondary hypertension in a blood pressure clinic. Arch Intern Med 147:1289–1293

    Article  CAS  PubMed  Google Scholar 

  28. Kaplan NM (2004) The current epidemic of primary aldosteronism: causes and consequences. J Hypertens 22:863–869

    Article  CAS  PubMed  Google Scholar 

  29. Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC (1994) High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 21(4):315–318

    Article  CAS  PubMed  Google Scholar 

  30. Kaplan NM (2011) Primary aldosteronism: a contrarian view. Rev Endocr Metab Disord 12(1):49–52

    Article  CAS  PubMed  Google Scholar 

  31. Rossi GP (2004) Primary aldosteronism: a needle in a haystack or a yellow cab on Fifth Avenue? Curr Hypertens Rep 6(1):1–4

    Article  PubMed  Google Scholar 

  32. Funder JW, Carey RM, Fardella C, Endocrine Society et al (2008) Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 93:3266–3281

    Article  CAS  PubMed  Google Scholar 

  33. Rossi GP, Bernini G, Caliumi C et al (2006) A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol 48:2293–2300

    Article  CAS  PubMed  Google Scholar 

  34. Ito Y, Takeda R, Karashima S, Yamamoto Y, Yoneda T, Takeda Y (2011) Prevalence of primary aldosteronism among prehypertensive and stage 1 hypertensive subjects. Hypertens Res 34(1):98–102

    Article  CAS  PubMed  Google Scholar 

  35. Westerdahl C, Bergenfelz A, Isaksson A, Nerbrand C, Valdemarsson S (2011) Primary aldosteronism among newly diagnosed and untreated hypertensive patients in a Swedish primary care area. Scand J Prim Health Care 29(1):57–62

    PubMed  PubMed Central  Google Scholar 

  36. Mosso L, Carvajal C, Gonzalez A, Barraza A, Avila F, Montero J, Huete A, Gederlini A, Fardella CE (2003) Primary aldosteronism and hypertensive disease. Hypertension 42:161–165

    Article  CAS  PubMed  Google Scholar 

  37. Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourard JJ (2005) Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 45:1243–1248

    Article  CAS  PubMed  Google Scholar 

  38. Born-Frontsberg E, Reincke M, Rump LC, Hahner S, Diederich S, Lorenz R, Allolio B, Seufert J, Schirpenbach C, Beuschlein F, Bidlingmaier M, Endres S, Quinkler M, Participants of the German Conn’s Registry (2009) Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn’s Registry. J Clin Endocrinol Metab 94:1125–1130

    Article  CAS  PubMed  Google Scholar 

  39. Savard S, Amar L, Plouin PF, Steichen O (2013) Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension 62:331–336

    Article  CAS  PubMed  Google Scholar 

  40. Strauch B, Petrak O, Wichterle D et al (2006) Increased arterial wall stiffness in primary aldosteronism in comparison with essential hypertension. Am J Hypertens 19:909–914

    Article  PubMed  Google Scholar 

  41. Lin YH, Lee HH, Liu KL et al (2011) Reversal of myocardial fibrosis in patients with unilateral hyperaldosteronism receiving adrenalectomy. Surgery 150:526–533

    Article  PubMed  Google Scholar 

  42. Sechi LA, Novello M, Lapenna R et al (2006) Long-term renal outcomes in patients with primary aldosteronism. JAMA 295:2638–2645

    Article  CAS  PubMed  Google Scholar 

  43. Nishizaka MK, Zaman MA, Green SA et al (2004) Impaired endothelium-dependent flow-mediated vasodilation in hypertensive subjects with hyperaldosteronism. Circulation 109:2857–2861

    Article  CAS  PubMed  Google Scholar 

  44. Su MY, Wu VC, Yu HY et al (2012) Contrast-enhanced MRI index of diffuse myocardial fibrosis is increased in primary aldosteronism. J Magn Reson Imaging 35:1349–1355

    Article  PubMed  Google Scholar 

  45. Maule S, Mulatero P, Milan A et al (2006) QT interval in patients with primary aldosteronism and low-renin essential hypertension. J Hypertens 24:2459–2464

    Article  CAS  PubMed  Google Scholar 

  46. Mulatero P, Monticone S, Bertello C et al (2013) Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab 98:4826–4833

    Article  CAS  PubMed  Google Scholar 

  47. Fallo F, Veglio F, Bertello C et al (2006) Prevalence and characteristics of the metabolic syndrome in primary aldosteronism. J Clin Endocrinol Metab 91:454–459

    Article  CAS  PubMed  Google Scholar 

  48. Fischer E, Adolf C, Pallauf A et al (2013) Aldosterone excess impairs first phase insulin secretion in primary aldosteronism. J Clin Endocrinol Metab 98:2513–2520

    Article  CAS  PubMed  Google Scholar 

  49. Reincke M, Fischer E, Gerum S, Merkle K, Schulz S, Pallauf A, Quinkler M, Hanslik G, Lang K, Hahner S, Allolio B, Meisinger C, Holle R, Beuschlein F, Bidlingmaier M, Endres S (2012) Observational study mortality in treated primary aldosteronism: the German Conn’s registry. Hypertension 60:618–624

    Article  CAS  PubMed  Google Scholar 

  50. Kearney PM, Whelton M, Reynolds K et al (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365:217–223

    Article  PubMed  Google Scholar 

  51. Nishikawa T, Omura M, Satoh F et al (2011) Guidelines for the diagnosis and treatment of primary aldosteronism – the Japan Endocrine Society 2009. Endocr J 58:711–721

    Article  CAS  PubMed  Google Scholar 

  52. Monticone S, Viola A, Tizzani D, Crudo V, Burrello J, Galmozzi M, Veglio F, Mulatero P (2012) Primary aldosteronism: who should be screened? Horm Metab Res 44(3):163–169

    Article  CAS  PubMed  Google Scholar 

  53. Hiramatsu K, Yamada T, Yukimura Y, Komiya I, Ichikawa K, Ishihara M, Nagata H, Izumiyama T (1981) A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity: results in hypertensive patients. Arch Intern Med 141:1589–1593

    Article  CAS  PubMed  Google Scholar 

  54. Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, Gomez-Sanchez CE, Veglio F, Young WF Jr (2004) Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab 89:1045–1050

    Article  CAS  PubMed  Google Scholar 

  55. Luo Q, Li NF, Yao XG, Zhang DL, Abulikemu SF, Chang GJ, Zhou KM, Wang GL, Wang MH, Ouyang WJ, Cheng QY, Jia Y (2016) Potential effects of age on screening for primary aldosteronism. J Hum Hypertens 30(1):53–61

    Article  PubMed  CAS  Google Scholar 

  56. Mulatero P, Rabbia F, Milan A et al (2002) Drug effects on aldosterone/plasma renin activity ration in primary aldosteronism. Hypertension 40:897–902

    Article  CAS  PubMed  Google Scholar 

  57. Browne GA, Griffin TP, O'Shea PM, Dennedy MC (2015) β-Blocker withdrawal is preferable for accurate interpretation of the aldosterone-renin ratio in chronically treated hypertension. Clin Endocrinol (Oxf) 84:325–331 [Epub ahead of print]

    Article  CAS  Google Scholar 

  58. Tiu S-C, Choi C-H, Shek C-C, Ng Y-W, Chan FKW, Ng C-M et al (2005) The use of aldosterone-renin ratio as a diagnostic test for primary hyperaldosteronism and its test characteristics under different conditions of blood sampling. J Clin Endocrinol Metab 90(1):72–78

    Article  CAS  PubMed  Google Scholar 

  59. Barigou M, Ah-Kang F, Orloff E, Amar J, Chamontin B, Bouhanick B (2015) Effect of postural changes on aldosterone to plasma renin ratio in patients with suspected secondary hypertension. Ann Cardiol Angeiol (Paris) 64(3):169–174

    Article  CAS  Google Scholar 

  60. Ahmed AH, Gordon RD, Ward G, Wolley M, Kogovsek C, Stowasser M (2015) Should aldosterone suppression tests be conducted during a particular phase of the menstrual cycle, and if so, which phase? Results of a preliminary study. Clin Endocrinol (Oxf) 83(3):303–307

    Article  CAS  Google Scholar 

  61. Fischer E, Reuschl S, Quinkler M, Rump LC, Hahner S, Bidlingmaier M, Reincke M, Participants of the German Conn’s Registry – Else Kröner-Fresenius-Hyperaldosteronism Registry (2013) Assay characteristics influence the aldosterone to renin ratio as a screening tool for primary aldosteronism: results of the German Conn’s registry. Horm Metab Res 45(7):526–531

    Article  CAS  PubMed  Google Scholar 

  62. Lonati C, Bassani N, Gritti A, Biganzoli E, Morganti A (2014) Measurement of plasma renin concentration instead of plasma renin activity decreases the positive aldosterone-to-renin ratio tests in treated patients with essential hypertension. J Hypertens 32(3):627–634

    Article  CAS  PubMed  Google Scholar 

  63. Manolopoulou J, Fischer E, Dietz A, Diederich S, Holmes D, Junnila R, Grimminger P, Reincke M, Morganti A, Bidlingmaier M (2015) Clinical validation for the aldosterone-to-renin ratio and aldosterone suppression testing using simultaneous fully automated chemiluminescence immunoassays. J Hypertens 33(12):2500–2511

    Article  CAS  PubMed  Google Scholar 

  64. Pizzolo F, Zorzi F, Chiecchi L et al (2014) NT-proBNP, a useful tool in hypertensive patients undergoing a diagnostic evaluation for primary aldosteronism. Endocrine 45:479–486

    Article  CAS  PubMed  Google Scholar 

  65. Young WF (2007) Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf) 66:607–618

    Article  CAS  Google Scholar 

  66. Williams JS, Williams GH, Raji A, Jeunemaitre X, Brown NJ, Hopkins PN, Conlin PR (2006) Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia. J Hum Hypertens 20:129–136

    Article  CAS  PubMed  Google Scholar 

  67. Ahmed AH, Cowley D, Wolley M et al (2014) Seated saline suppression testing for the diagnosis of primary aldosteronism: a preliminary study. J Clin Endocrinol Metab 99:2745–2753

    Article  CAS  PubMed  Google Scholar 

  68. Stowasser M, Gordon RD, Gunasekera TG et al (2003) High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non-selective’ screening of hypertensive patients. J Hypertens 21:2149–2157

    Article  CAS  PubMed  Google Scholar 

  69. Gouli A, Kaltsas G, Tzonou A et al (2011) High prevalence of autonomous aldosterone secretion among patients with essential hypertension. Eur J Clin Invest 41:1227–1236

    Article  CAS  PubMed  Google Scholar 

  70. Lyons DF, Kem DC, Brown RD et al (1983) Single dose captopril as a diagnostic test for primary aldosteronism. J Clin Endocrinol Metab 57:892–896

    Article  CAS  PubMed  Google Scholar 

  71. Agharazii M, Douville P, Grose JH, Lebel M (2001) Captopril suppression versus salt loading in confirming primary aldosteronism. Hypertension 37:1440–1443

    Article  CAS  PubMed  Google Scholar 

  72. Castro OL, Yu X, Kem DC (2002) Diagnostic value of the post-captopril test in primary aldosteronism. Hypertension 39:935–938

    Article  CAS  PubMed  Google Scholar 

  73. Mulatero P, Bertello C, Garrone C et al (2007) Captopril test can give misleading results in patients with suspect primary aldosteronism. Hypertension 50:e26–e27

    Article  CAS  PubMed  Google Scholar 

  74. Westerdahl C, Bergenfelz A, Isaksson A, Valdemarsson S (2011) Captopril suppression: limitations for confirmation of primary aldosteronism. J Renin Angiotensin Aldosterone Syst 12:326–332

    Article  CAS  PubMed  Google Scholar 

  75. Giacchetti G, Ronconi V, Lucarelli G et al (2006) Analysis of screening and confirmatory tests in the diagnosis of primary aldosteronism: need for a standardized protocol. J Hypertens 24:737–745

    Article  CAS  PubMed  Google Scholar 

  76. Wu VC, Chang HW, Liu KL et al (2009) Primary aldosteronism: diagnostic accuracy of the losartan and captopril tests. Am J Hypertens 22:821–827

    Article  CAS  PubMed  Google Scholar 

  77. Kuo CC, Balakrishnan P, Hsein YC et al (2015) The value of losartan suppression test in the confirmatory diagnosis of primary aldosteronism in patients over 50 years old. J Renin Angiotensin Aldosterone Syst 16(3):587–598

    Article  CAS  PubMed  Google Scholar 

  78. Stowasser M, Gordon RD, Rutherford JC et al (2001) Diagnosis and management of primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2:156–169

    Article  CAS  PubMed  Google Scholar 

  79. Rossi GP, Belfiore A, Bernini G, Primary Aldosteronism Prevalence in Italy Study Investigators et al (2007) Comparison of the captopril and the saline infusion test for excluding aldosterone-producing adenoma. Hypertension 50:424–431

    Article  CAS  PubMed  Google Scholar 

  80. Schirpenbach C, Seiler L, Maser-Gluth C et al (2006) Confirmatory testing in normokalaemic primary aldosteronism: the value of the saline infusion test and urinary aldosterone metabolites. Eur J Endocrinol 154:865–873

    Article  CAS  PubMed  Google Scholar 

  81. Taylor PJ, Cooper DP, Gordon RD, Stowasser M (2009) Measurement of aldosterone in human plasma by semi-automated HPLC-tandem mass spectrometry. Clin Chem 55:1155–1162

    Article  CAS  PubMed  Google Scholar 

  82. Hinchliffe E, Carter S, Owen LJ, Keevil BG (2013) Quantitation of aldosterone in human plasma by ultra high performance liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 913–914:19–23

    Article  PubMed  CAS  Google Scholar 

  83. Van Der Gugten JG, Dubland J, Liu HF, Wang A, Joseph C, Holmes DT (2012) Determination of serum aldosterone by liquid chromatography and tandem mass spectrometry: a liquid-liquid extraction method for the ABSCIEX API-5000 mass spectrometry system. J Clin Pathol 65:457–462

    Article  CAS  Google Scholar 

  84. Camenzind AG, van der Gugten JG, Popp R, Holmes DT, Borchers CH (2013) Development and evaluation of an immuno-MALDI (iMALDI) assay for angiotensin I and the diagnosis of secondary hypertension. Clin Proteomics 10:20

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  85. Dorrian CA, Toole BJ, Alvarez-Madrazo S et al (2010) A screening procedure for primary aldosteronism based on the Diasorin Liaison automated chemiluminescent immunoassay for direct renin. Ann Clin Biochem 47:195–199

    Article  CAS  PubMed  Google Scholar 

  86. Young WF, Stanson AW, Thompson GB et al (2004) Role for adrenal venous sampling in primary aldosteronism. Surgery 136:1227–1235

    Article  PubMed  Google Scholar 

  87. Elliot P, Holmes DT (2013) Adrenal vein sampling: substantial need for technical improvement at regional referral centers. Clin Biochem 46:1399–1404

    Article  Google Scholar 

  88. Pasternak JD, Epelboym I, Seiser N et al (2016) Diagnostic utility of data from adrenal venous sampling for primary aldosteronism despite failed cannulation of the right adrenal vein. Surgery 159:267–274

    Article  PubMed  Google Scholar 

  89. Harvey A, Kline G, Pasieka JL (2006) Adrenal venous sampling in primary hyperaldosteronism: comparison of radiographic with biochemical success and the clinical decision making with “less than ideal” testing. Surgery 140:847–853

    Article  PubMed  Google Scholar 

  90. Young WF, Klee GG (1988) Primary aldosteronism. Diagnostic evaluation. Endocrinol Metab Clin North Am 17:367–395

    PubMed  Google Scholar 

  91. Harvey A, Pasieka JL, Kline G, So B (2012) Modification of the protocol for selective adrenal venous sampling results in both a significant increase in the accuracy and necessity of the procedure in the management of patients with primary hyperaldosteronism. Surgery 152:643–649

    Article  PubMed  Google Scholar 

  92. Vonend O, Ockenfels N, Gao X et al (2011) Adrenal venous sampling: evaluation of the German Conn’s registry. Hypertension 57:990–995

    Article  CAS  PubMed  Google Scholar 

  93. Daunt N (2005) Adrenal vein sampling: how to make it quick, easy, and successful. Radiographics 25(suppl 1):S143–S158

    Article  PubMed  Google Scholar 

  94. Onozawa S, Murata S, Tajima H et al (2014) Evaluation of right adrenal vein cannulation by computed tomography angiography in 140 consecutive patients undergoing adrenal venous sampling. Eur J Endocrinol 170:601–608

    Article  CAS  PubMed  Google Scholar 

  95. Park SI, Rhee Y, Lim JS et al (2014) Right adrenal venography findings correlated with C-arm CT for selection during C-arm CT-assisted adrenal vein sampling in primary aldosteronism. Cardiovasc Intervent Radiol 37(6):1469–1475

    Article  PubMed  Google Scholar 

  96. Rossi E, Regolisti G, Perazzoli F et al (2011) Intraprocedural cortisol measurement increases adrenal vein sampling success rate in primary aldosteronism. Am J Hypertens 24:1280–1285

    Article  CAS  PubMed  Google Scholar 

  97. Monticone S, Viola A, Rossato D et al (2015) Adrenal vein sampling in primary aldosteronism: towards a standardised protocol. Lancet Diabetes Endocrinol 3(4):296–303

    Article  CAS  PubMed  Google Scholar 

  98. Kline GA, Pasieka JL, Harvey A, So B, Dias VC (2014) A marked proportional rise in IVC aldosterone following cosyntropin administration during AVS is a signal to the presence of adrenal hyperplasia in primary aldosteronism. J Hum Hypertens 28:298–302

    Article  CAS  PubMed  Google Scholar 

  99. Seccia TM, Miotto D, De Toni R et al (2009) Adrenocorticotropic hormone stimulation during adrenal vein sampling for identifying surgically curable subtypes of primary aldosteronism: comparison of 3 different protocols. Hypertension 53:761–766

    Article  CAS  PubMed  Google Scholar 

  100. Monticone S, Satoh F, Giacchetti G et al (2012) Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling in primary aldosteronism. Hypertension 59:840–846

    Article  CAS  PubMed  Google Scholar 

  101. Teng J, Hutchinson ME, Doery JC et al (2015) Role of adrenal vein sampling in primary aldosteronism: the Monash Health experience. Intern Med J 45(11):1141–1146

    Article  CAS  PubMed  Google Scholar 

  102. Rossi GP, Auchus RJ, Brown M et al (2014) An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension 63:151–160

    Article  CAS  PubMed  Google Scholar 

  103. Satoh F, Morimoto R, Seiji K et al (2015) Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism? Eur J Endocrinol 173(4):465–477

    Article  CAS  PubMed  Google Scholar 

  104. Hammarstedt L, Muth A, Wangberg B et al (2010) Adrenal lesion frequency: a prospective, cross-sectional CT study in a defined region, including systematic re-evaluation. Acta Radiol 51:1149–1156

    Article  PubMed  Google Scholar 

  105. Rossi GP, Sacchetto A, Chiesura-Corona M et al (2001) Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal computed tomography and magnetic resonance findings: results in 104 consecutive cases. J Clin Endocrinol Metab 86:1083–1090

    Article  CAS  PubMed  Google Scholar 

  106. White ML, Gauger PG, Doherty GM et al (2008) The role of radiologic studies in the evaluation and management of primary hyperaldosteronism. Surgery 144:926–933

    Article  PubMed  Google Scholar 

  107. Zarnegar R, Bloom AI, Lee J et al (2008) Is adrenal venous sampling necessary in all patients with hyperaldosteronism before adrenalectomy? J Vasc Interv Radiol 19:66–71

    Article  PubMed  Google Scholar 

  108. Lin TP, Chiu AW, Chen M et al (2015) Adrenal computed tomography and NP-59 usefulness for diagnosing aldosterone-producing adenomas and idiopathic hyperaldosteronism in primary hyperaldosteronism. Urol Sci 34:1–5

    Google Scholar 

  109. Patel SM, Lingam RK, Beaconsfield TI et al (2007) Role of radiology in the management of primary aldosteronism. Radiographics 27:1145–1157

    Article  PubMed  Google Scholar 

  110. Kempers MJ, Lenders JW, van Outheusden L et al (2009) Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med 151:329–337

    Article  PubMed  Google Scholar 

  111. Raman SP, Lessne M, Kawamoto S et al (2015) 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 39(3):414–418

    PubMed  Google Scholar 

  112. Burton TJ, Mackenzie IS, Balan K et al (2012) Evaluation of the sensitivity and specificity of (11)C-metomidate positron emission tomography (PET)-CT for lateralizing aldosterone secretion by Conn’s adenomas. J Clin Endocrinol Metab 97:100–109

    Article  CAS  PubMed  Google Scholar 

  113. Lu CC, Wu VC, Wu KD et al (2014) Prognostic value of semiquantification NP-59 SPECT/CT in primary aldosteronism patients after adrenalectomy. Eur J Nucl Med Mol Imaging 41:1375–1384

    Article  CAS  PubMed  Google Scholar 

  114. Choi M, Scholl UI, Yue P et al (2011) K+ channel mutations in adrenal aldosterone-producing adenomas and hereditary hypertension. Science 331:768–772

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. Boulkroun S, Beuschlein F, Rossi GP et al (2012) Prevalence, clinical, and molecular correlates of KCNJ5 mutations in primary aldosteronism. Hypertension 59:592–598

    Article  CAS  PubMed  Google Scholar 

  116. Beuschlein F, Boulkroun S, Osswald A et al (2013) Somatic mutations in ATP1A1 and ATP2B3 lead to aldosterone-producing adenomas and secondary hypertension. Nat Genet 45:440–444

    Article  CAS  PubMed  Google Scholar 

  117. Scholl UI, Goh G, Stolting G et al (2013) Somatic and germline CACNA1D calcium channel mutations in aldosterone producing adenomas and primary aldosteronism. Nat Genet 45:1050–1054

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  118. Akerstrom T, Crona J, Delgado Verdugo A et al (2012) Comprehensive re-sequencing of adrenal aldosterone producing lesions reveal three somatic mutations near the KCNJ5 potassium channel selectivity filter. PLoS One 7:e41926

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  119. Kuppusamy M, Caroccia B, Stindl J et al (2014) A novel KCNJ5-insT149 somatic mutation close to, but outside, the selectivity filter causes resistant hypertension by loss of selectivity for potassium. J Clin Endocrinol Metab 99:E1765–E1773

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. Shen WT, Lim RC, Siperstein AE et al (1999) Laparoscopic vs open adrenalectomy for the treatment of primary hyperaldosteronism. Arch Surg 134:628–631

    Article  CAS  PubMed  Google Scholar 

  121. Viola A, Tizzani D, Monticone S et al (2013) Diagnosis and treatment of unilateral forms of primary aldosteronism. Curr Hypertens Rev 9:156–165

    Article  CAS  PubMed  Google Scholar 

  122. van der Linden P, Steichen O, Zinzindohoue F et al (2012) Blood pressure and medication changes following adrenalectomy for unilateral primary aldosteronism: a follow-up study. J Hypertens 30:761–769

    Article  PubMed  CAS  Google Scholar 

  123. Rossitto G, Regolisti G, Rossi E et al (2013) Elevation of angiotensin-II type-1-receptor autoantibodies titer in primary aldosteronism as a result of aldosterone-producing adenoma. Hypertension 61:526–533

    Article  CAS  PubMed  Google Scholar 

  124. Kem DC, Li H, Velarde-Miranda C et al (2014) Autoimmune mechanisms activating the angiotensin AT1 receptor in primary aldosteronism. J Clin Endocrinol Metab 99:1790–1797

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  125. Li H, Yu X, Cicala MV et al (2015) Prevalence of angiotensin II type 1 receptor (AT1R)-activating autoantibodies in primary aldosteronism. J Am Soc Hypertens 9:15–20

    Article  CAS  PubMed  Google Scholar 

  126. Sawka AM, Young WF, Thompson GB et al (2001) Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 135:258–261

    Article  CAS  PubMed  Google Scholar 

  127. Rossi GP, Bolognesi M, Rizzoni D et al (2008) Vascular remodelling and duration of hypertension predict outcome of adrenalectomy in primary aldosteronism patients. Hypertension 51:1366–1371

    Article  CAS  PubMed  Google Scholar 

  128. Zarnegar R, Young WF, Lee J et al (2008) The aldosteronoma resolution score: predicting complete resolution of hypertension after adrenalectomy for aldosteronoma. Ann Surg 247:511–518

    Article  PubMed  Google Scholar 

  129. Weigel M, Riester A, Hanslik G et al (2015) Post-saline infusion test aldosterone levels indicate severity and outcome in primary aldosteronism. Eur J Endocrinol 172(4):443–450

    Article  CAS  PubMed  Google Scholar 

  130. Jacobsen NE, Campbell JB, Hobart MG (2003) Laparoscopic versus open adrenalectomy for surgical adrenal disease. Can J Urol 10:1995–1999

    PubMed  Google Scholar 

  131. Fu B, Zhang X, Wang G-X, Lang B, Ma X, Li H-Z et al (2011) Long-term results of a prospective, randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 185:1578–1582

    Article  PubMed  Google Scholar 

  132. Ishidoya S, Ito A, Sakai K et al (2005) Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 174:40–43

    Article  PubMed  Google Scholar 

  133. Shimabuku M, Sasaki A, Higa M, Kakazu M, Asato M, Shiroma H (2011) Single-incision laparoscopic adrenalectomy for primary aldosteronism: report of a case. Surg Today 41:1306–1309

    Article  PubMed  Google Scholar 

  134. Colon MJ, Lemasters P, Newell P, Divino C, Weber KJ, Chin EH (2011) Laparoscopic single site adrenalectomy using a conventional laparoscope and instrumentation. JSLS 15:236–238

    Article  PubMed  PubMed Central  Google Scholar 

  135. Jeunemaitre X, Chatellier G, Kreft-Jais C et al (1987) Efficacy and tolerance of spironolactone in essential hypertension. Am J Cardiol 60:820–825

    Article  CAS  PubMed  Google Scholar 

  136. Parthasarathy HK, Ménard J, White WB et al (2011) A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens 29:980–990

    Article  CAS  PubMed  Google Scholar 

  137. Amar L, Azizi M, Menard J, Peyrard S, Plouin PF (2013) Sequential comparison of aldosterone synthase inhibition and mineralocorticoid blockade in patients with primary aldosteronism. J Hypertens 31:624–629

    Article  CAS  PubMed  Google Scholar 

  138. Pitt B, Kober L, Ponikowski P et al (2013) Safety and tolerability of the novel non-steroidal mineralocorticoid receptor antagonist BAY94–8862 in patients with chronic heart failure and mild or moderate chronic kidney disease: a randomized, double-blind trial. Eur Heart J 34:2453–2463

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  139. Fischer E, Beuschlein F, Degenhart C et al (2012) Spontaneous remission of idiopathic aldosteronism after long-term treatment with spironolactone: results from the German Conn’s Registry. Clin Endocrinol (Oxf) 76(4):473–477

    Article  CAS  Google Scholar 

  140. Lucatello B, Benso A, Tabaro I et al (2013) Long-term re-evaluation of primary aldosteronism after medical treatment reveals high proportion of normal mineralocorticoid secretion. Eur J Endocrinol 168(4):525–532

    Article  CAS  PubMed  Google Scholar 

  141. Catena C, Colussi G, Lapenna R et al (2007) Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 50:911–918

    Article  CAS  PubMed  Google Scholar 

  142. Ahmed AH, Gordon RD, Sukor N et al (2011) Quality of life in patients with bilateral primary aldosteronism before and during treatment with spironolactone and/or amiloride, including a comparison with our previously published results in those with unilateral disease treated surgically. J Clin Endocrinol Metab 96:2904–2911

    Article  CAS  PubMed  Google Scholar 

  143. Marzano L, Colussi G, Sechi LA, Catena C (2015) Adrenalectomy is comparable with medical treatment for reduction of left ventricular mass in primary aldosteronism: meta-analysis of long-term studies. Am J Hypertens 28:312–318. doi:10.1093/ajh/hpu154

    Article  PubMed  Google Scholar 

  144. Miyake Y, Tanaka K, Nishikawa T et al (2014) Prognosis of primary aldosteronism in Japan: results from a nationwide epidemiological study. Endocr J 61:35–40

    Article  PubMed  Google Scholar 

  145. Sechi LA, Colussi GL, Novello M et al (2015) Mineralocorticoid receptor antagonists and clinical outcomes in primary aldosteronism: as good as surgery? Horm Metab Res 47:1000–1006

    Article  CAS  PubMed  Google Scholar 

  146. Rossi GP, Dalla CA (2014) Clinical management of primary aldosteronism: 2013 practical recommendations of the Italian Society of Hypertension (SIIA). High Blood Press Cardiovasc Prev 21(1):71–75

    Article  CAS  PubMed  Google Scholar 

  147. Kline GA, Pasieka JL, Harvey A, So B, Dias VC (2014) High-probability features of primary aldosteronism may obviate the need for confirmatory testing without increasing false-positive diagnoses. J Clin Hypertens 16:488–496

    Google Scholar 

  148. Küpers EM, Amar L, Raynaud A, Plouin PF, Steichen O (2012) A clinical prediction score to diagnose unilateral primary aldosteronism. J Clin Endocrinol Metab 97:3530–3537

    Article  PubMed  CAS  Google Scholar 

  149. Riester A, Fischer E, Degenhart C et al (2014) Age below 40 or a recently proposed clinical prediction score cannot bypass adrenal venous sampling in primary aldosteronism. J Clin Endocrinol Metab 99:E1035–E1039

    Article  CAS  PubMed  Google Scholar 

  150. Sze WC, Soh LM, Lau JH et al (2014) Diagnosing unilateral primary aldosteronism – comparison of a clinical prediction score, computed tomography and adrenal venous sampling. Clin Endocrinol (Oxf) 81:25–30

    Article  Google Scholar 

  151. Mulatero P, di Cella SM, Monticone S et al (2012) 18-hydroxycorticosterone, 18-hydroxycortisol and 18-oxocortisol in the diagnosis of primary aldosteronism and its subtypes. J Clin Endocrinol Metab 97:881–889

    Article  CAS  PubMed  Google Scholar 

  152. Satoh F, Morimoto R, Ono Y et al (2015) Measurement of peripheral plasma 18-oxocortisol can discriminate unilateral adenoma from bilateral diseases in patients with primary aldosteronism. Hypertension 65:1096–1102

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  153. Asmar M, Wachtel H, Yan Y et al (2015) Reversing the established order: should adrenal venous sampling precede cross-sectional imaging in the evaluation of primary aldosteronism? J Surg Oncol 112(2):144–148

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece

    Michael Doumas

  2. Hippokration General Hospital, 49, Konstantinoupoleos Street, Thessaloniki, 54643, Greece

    Michael Doumas

  3. 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece

    Stella Douma

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Correspondence to Michael Doumas .

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  1. First Cardiology Clinic, National and Kapodistrian University of Athens, Athens, Greece

    Costas Tsioufis

  2. Department of Nephrology and Hypertension, University Hospital Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany

    Roland E. Schmieder

  3. IRCCS Istituto Auxologico Italiano, University Milano-Bicocca, Milano Monza, Italy

    Giuseppe Mancia

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Doumas, M., Douma, S. (2016). 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. Springer, Cham. https://doi.org/10.1007/978-3-319-34141-5_2

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