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{{Primary hyperaldosteronism}} | {{Primary hyperaldosteronism}} | ||
{{CMG}};{{AE}}{{HK}} | |||
==Overview== | |||
If left untreated, patients with primary hyperaldosteronism may progress to develop [[stroke]], [[Coronary heart disease|coronary artery disease]], and [[renal insufficiency]] with associated [[proteinuria]]. Aldosterone producing adenomas (APAs) continue to grow slowly over time. The [[aldosterone]] production likely correlates with the size of the [[adenoma]]. It is a progressive disease and its common complications include [[left ventricular hypertrophy]] due to [[chronic hypertension]], [[atrial fibrillation]], [[myocardial infarction]], [[stroke]], [[proteinuria]], and [[metabolic syndrome]]. The [[prognosis]] of primary hyperaldosteronism is good with treatment. Without treatment, primary hyperaldosteronism will result in [[hypertension]] with resultant [[hypertension]]-related complications, which may be a major cause of [[Morbidity & Mortality|morbidity and mortality]] among patients. | |||
==Natural History, Complications, and Prognosis== | |||
=== Natural History === | |||
*Primary hyperaldosteronism without treatment, leads to progressive increase in disease severity, eventually leading to involvement of both adrenals.<ref name="pmid9247760">{{cite journal |vauthors=Gordon RD |title=Primary aldosteronism: a new understanding |journal=Clin. Exp. Hypertens. |volume=19 |issue=5-6 |pages=857–70 |year=1997 |pmid=9247760 |doi= |url= |issn=}}</ref> | |||
*If left untreated, patients with primary hyperaldosteronism may progress to develop severe resistant [[hypertension]] leading to [[stroke]], [[Coronary heart disease|coronary artery disease]], and [[renal insufficiency]] with associated [[proteinuria]].<ref name="urlCardiovascular complications in patients with primary aldosteronism - ScienceDirect">{{cite web |url=http://www.sciencedirect.com/science/article/pii/S0272638699702982?via%3Dihub |title=Cardiovascular complications in patients with primary aldosteronism - ScienceDirect |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref> | |||
===Complications=== | |||
Primary aldosteronism is characterized by the development of the following complications:<ref name="pmid10023636">{{cite journal |vauthors=Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura G |title=Cardiovascular complications in patients with primary aldosteronism |journal=Am. J. Kidney Dis. |volume=33 |issue=2 |pages=261–6 |year=1999 |pmid=10023636 |doi= |url= |issn=}}</ref><ref name="pmid19356005">{{cite journal |vauthors=Giacchetti G, Turchi F, Boscaro M, Ronconi V |title=Management of primary aldosteronism: its complications and their outcomes after treatment |journal=Curr Vasc Pharmacol |volume=7 |issue=2 |pages=244–49 |year=2009 |pmid=19356005 |doi= |url= |issn=}}</ref><ref name="pmid20119885">{{cite journal |vauthors=Reincke M, Meisinger C, Holle R, Quinkler M, Hahner S, Beuschlein F, Bidlingmaier M, Seissler J, Endres S |title=Is primary aldosteronism associated with diabetes mellitus? Results of the German Conn's Registry |journal=Horm. Metab. Res. |volume=42 |issue=6 |pages=435–9 |year=2010 |pmid=20119885 |doi=10.1055/s-0029-1246189 |url= |issn=}}</ref><ref name="pmid26311088">{{cite journal |vauthors=Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A |title=Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry |journal=Eur. J. Endocrinol. |volume=173 |issue=5 |pages=665–75 |year=2015 |pmid=26311088 |doi=10.1530/EJE-15-0450 |url= |issn=}}</ref><ref name="pmid9221268">{{cite journal |vauthors=Gordon RD |title=Primary aldosteronism |journal=J. Endocrinol. Invest. |volume=18 |issue=7 |pages=495–511 |year=1995 |pmid=9221268 |doi=10.1007/BF03349761 |url= |issn=}}</ref><ref name="urlPrevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://academic.oup.com/jcem/article/91/2/454/2843303/Prevalence-and-Characteristics-of-the-Metabolic |title=Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref> | |||
'''Cardiovascular complications''' | |||
*[[Left ventricular hypertrophy]] | |||
*[[Myocardial infarction]] | |||
*[[Atrial fibrillation]] | |||
'''Neurological complications''' | |||
*[[Stroke]]<ref name="pmid9221268">{{cite journal |vauthors=Gordon RD |title=Primary aldosteronism |journal=J. Endocrinol. Invest. |volume=18 |issue=7 |pages=495–511 |year=1995 |pmid=9221268 |doi=10.1007/BF03349761 |url= |issn=}}</ref> | |||
*[[Hypertensive encephalopathy|Hypertensive encephelopathy]] | |||
'''Renal complications''' | |||
*[[Proteinuria]] including [[microalbuminuria]]<ref name="pmid21738054">{{cite journal |vauthors=Wu VC, Kuo CC, Wang SM, Liu KL, Huang KH, Lin YH, Chu TS, Chang HW, Lin CY, Tsai CT, Lin LY, Chueh SC, Kao TW, Chen YM, Chiang WC, Tsai TJ, Ho YL, Lin SL, Wang WJ, Wu KD |title=Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment |journal=J. Hypertens. |volume=29 |issue=9 |pages=1778–86 |year=2011 |pmid=21738054 |doi=10.1097/HJH.0b013e3283495cbb |url= |issn=}}</ref> | |||
*[[Renal cyst|Renal cysts]]<ref name="pmid17563567">{{cite journal |vauthors=Novello M, Catena C, Nadalini E, Colussi GL, Baroselli S, Chiuch A, Lapenna R, Bazzocchi M, Sechi LA |title=Renal cysts and hypokalemia in primary aldosteronism: results of long-term follow-up after treatment |journal=J. Hypertens. |volume=25 |issue=7 |pages=1443–50 |year=2007 |pmid=17563567 |doi=10.1097/HJH.0b013e328126855b |url= |issn=}}</ref> | |||
'''Metabolic complications''' | |||
*[[Metabolic syndrome]]<ref name="pmid17442220">{{cite journal |vauthors=Fallo F, Federspil G, Veglio F, Mulatero P |title=The metabolic syndrome in primary aldosteronism |journal=Curr. Hypertens. Rep. |volume=9 |issue=2 |pages=106–11 |year=2007 |pmid=17442220 |doi= |url= |issn=}}</ref><ref name="urlMetabolic syndrome in primary aldosteronism and essential hypertension: Relationship to adiponectin gene variants - ScienceDirect">{{cite web |url=http://www.sciencedirect.com/science/article/pii/S0939475309000635 |title=Metabolic syndrome in primary aldosteronism and essential hypertension: Relationship to adiponectin gene variants - ScienceDirect |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><ref name="pmid19481913">{{cite journal |vauthors=Ronconi V, Turchi F, Rilli S, Di Mattia D, Agostinelli L, Boscaro M, Giacchetti G |title=Metabolic syndrome in primary aldosteronism and essential hypertension: relationship to adiponectin gene variants |journal=Nutr Metab Cardiovasc Dis |volume=20 |issue=2 |pages=93–100 |year=2010 |pmid=19481913 |doi=10.1016/j.numecd.2009.03.007 |url= |issn=}}</ref> | |||
*[[Diabetes mellitus]]<ref name="pmid20119885">{{cite journal |vauthors=Reincke M, Meisinger C, Holle R, Quinkler M, Hahner S, Beuschlein F, Bidlingmaier M, Seissler J, Endres S |title=Is primary aldosteronism associated with diabetes mellitus? Results of the German Conn's Registry |journal=Horm. Metab. Res. |volume=42 |issue=6 |pages=435–9 |year=2010 |pmid=20119885 |doi=10.1055/s-0029-1246189 |url= |issn=}}</ref><ref name="urlPrevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic">{{cite web |url=https://academic.oup.com/jcem/article/91/2/454/2843303/Prevalence-and-Characteristics-of-the-Metabolic |title=Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref> | |||
===Prognosis=== | |||
*The [[prognosis]] of primary hyperaldosteronism is good with treatment. Without treatment, primary hyperaldosteronism will result in hypertension with resultant [[hypertension]]-related complications, which may be a major cause of [[Morbidity & Mortality|morbidity and mortality]] among patients. | |||
*[[Adrenalectomy]] lowers long-term all-cause mortality from primary hyperaldosteronism.<ref name="urlLong term outcome of Aldosteronism after target treatments | Scientific Reports">{{cite web |url=https://www.nature.com/articles/srep32103 |title=Long term outcome of Aldosteronism after target treatments | Scientific Reports |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><ref name="urlTreatment strategy and outcome with primary aldosteronism: a nationwide longitudinal cohort based study">{{cite web |url=http://www.endocrine-abstracts.org/ea/0035/ea0035OC2.5.htm |title=Treatment strategy and outcome with primary aldosteronism: a nationwide longitudinal cohort based study |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref><ref name="pmid8645073">{{cite journal |vauthors=Celen O, O'Brien MJ, Melby JC, Beazley RM |title=Factors influencing outcome of surgery for primary aldosteronism |journal=Arch Surg |volume=131 |issue=6 |pages=646–50 |year=1996 |pmid=8645073 |doi= |url= |issn=}}</ref> | |||
'''Patients undergoing unilateral adrenalectomy for unilateral adenoma''' | |||
*[[Adrenalectomy]] leads to cure of [[hypertension]] in 50% to 60% of patients.<ref name="pmid14597859">{{cite journal |vauthors=Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM |title=High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients |journal=J. Hypertens. |volume=21 |issue=11 |pages=2149–57 |year=2003 |pmid=14597859 |doi=10.1097/01.hjh.0000098141.70956.53 |url= |issn=}}</ref><ref name="pmid15134798">{{cite journal |vauthors=Stowasser M, Gordon RD |title=Primary aldosteronism--careful investigation is essential and rewarding |journal=Mol. Cell. Endocrinol. |volume=217 |issue=1-2 |pages=33–9 |year=2004 |pmid=15134798 |doi=10.1016/j.mce.2003.10.006 |url= |issn=}}</ref> | |||
*[[Blood pressure]] typically becomes normal after 1 to 6 months of the procedure.<ref name="pmid11881117">{{cite journal |vauthors=Stowasser M, Gordon RD, Rutherford JC, Nikwan NZ, Daunt N, Slater GJ |title=Diagnosis and management of primary aldosteronism |journal=J Renin Angiotensin Aldosterone Syst |volume=2 |issue=3 |pages=156–69 |year=2001 |pmid=11881117 |doi=10.3317/jraas.2001.022 |url= |issn=}}</ref> | |||
*Treatment leads to a significant increase in quality of life and improved [[cardiovascular]] outcomes. | |||
'''Patients receiving aldosterone antagonist medications''' | |||
*[[Hypertension]] is controlled in majority of the patients.<ref name="pmid14597859">{{cite journal |vauthors=Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM |title=High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients |journal=J. Hypertens. |volume=21 |issue=11 |pages=2149–57 |year=2003 |pmid=14597859 |doi=10.1097/01.hjh.0000098141.70956.53 |url= |issn=}}</ref><ref name="pmid15134798">{{cite journal |vauthors=Stowasser M, Gordon RD |title=Primary aldosteronism--careful investigation is essential and rewarding |journal=Mol. Cell. Endocrinol. |volume=217 |issue=1-2 |pages=33–9 |year=2004 |pmid=15134798 |doi=10.1016/j.mce.2003.10.006 |url= |issn=}}</ref> | |||
*Improvement is not as significant as [[adrenalectomy]] for unilateral lesions. | |||
'''Patients with FH-I undergoing treatment with glucocorticoid medications''' | |||
*[[Hypertension]] in familial hyperaldosteronism type I (FH-I) is usually of early onset and may be severe enough to cause early death, usually from [[hemorrhagic stroke]], unless specifically treated.<ref name="pmid9483237">{{cite journal |vauthors=Stowasser M, Gartside MG, Gordon RD |title=A PCR-based method of screening individuals of all ages, from neonates to the elderly, for familial hyperaldosteronism type I |journal=Aust N Z J Med |volume=27 |issue=6 |pages=685–90 |year=1997 |pmid=9483237 |doi= |url= |issn=}}</ref> | |||
*Treatment with [[glucocorticoids]], given in low doses is usually effective in controlling [[hypertension]] and consequently preventing [[stroke]]. | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 17:05, 3 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
If left untreated, patients with primary hyperaldosteronism may progress to develop stroke, coronary artery disease, and renal insufficiency with associated proteinuria. Aldosterone producing adenomas (APAs) continue to grow slowly over time. The aldosterone production likely correlates with the size of the adenoma. It is a progressive disease and its common complications include left ventricular hypertrophy due to chronic hypertension, atrial fibrillation, myocardial infarction, stroke, proteinuria, and metabolic syndrome. The prognosis of primary hyperaldosteronism is good with treatment. Without treatment, primary hyperaldosteronism will result in hypertension with resultant hypertension-related complications, which may be a major cause of morbidity and mortality among patients.
Natural History, Complications, and Prognosis
Natural History
- Primary hyperaldosteronism without treatment, leads to progressive increase in disease severity, eventually leading to involvement of both adrenals.[1]
- If left untreated, patients with primary hyperaldosteronism may progress to develop severe resistant hypertension leading to stroke, coronary artery disease, and renal insufficiency with associated proteinuria.[2]
Complications
Primary aldosteronism is characterized by the development of the following complications:[3][4][5][6][7][8]
Cardiovascular complications
Neurological complications
Renal complications
- Proteinuria including microalbuminuria[9]
- Renal cysts[10]
Metabolic complications
Prognosis
- The prognosis of primary hyperaldosteronism is good with treatment. Without treatment, primary hyperaldosteronism will result in hypertension with resultant hypertension-related complications, which may be a major cause of morbidity and mortality among patients.
- Adrenalectomy lowers long-term all-cause mortality from primary hyperaldosteronism.[14][15][16]
Patients undergoing unilateral adrenalectomy for unilateral adenoma
- Adrenalectomy leads to cure of hypertension in 50% to 60% of patients.[17][18]
- Blood pressure typically becomes normal after 1 to 6 months of the procedure.[19]
- Treatment leads to a significant increase in quality of life and improved cardiovascular outcomes.
Patients receiving aldosterone antagonist medications
- Hypertension is controlled in majority of the patients.[17][18]
- Improvement is not as significant as adrenalectomy for unilateral lesions.
Patients with FH-I undergoing treatment with glucocorticoid medications
- Hypertension in familial hyperaldosteronism type I (FH-I) is usually of early onset and may be severe enough to cause early death, usually from hemorrhagic stroke, unless specifically treated.[20]
- Treatment with glucocorticoids, given in low doses is usually effective in controlling hypertension and consequently preventing stroke.
References
- ↑ Gordon RD (1997). "Primary aldosteronism: a new understanding". Clin. Exp. Hypertens. 19 (5–6): 857–70. PMID 9247760.
- ↑ "Cardiovascular complications in patients with primary aldosteronism - ScienceDirect".
- ↑ Nishimura M, Uzu T, Fujii T, Kuroda S, Nakamura S, Inenaga T, Kimura G (1999). "Cardiovascular complications in patients with primary aldosteronism". Am. J. Kidney Dis. 33 (2): 261–6. PMID 10023636.
- ↑ Giacchetti G, Turchi F, Boscaro M, Ronconi V (2009). "Management of primary aldosteronism: its complications and their outcomes after treatment". Curr Vasc Pharmacol. 7 (2): 244–49. PMID 19356005.
- ↑ 5.0 5.1 Reincke M, Meisinger C, Holle R, Quinkler M, Hahner S, Beuschlein F, Bidlingmaier M, Seissler J, Endres S (2010). "Is primary aldosteronism associated with diabetes mellitus? Results of the German Conn's Registry". Horm. Metab. Res. 42 (6): 435–9. doi:10.1055/s-0029-1246189. PMID 20119885.
- ↑ Hanslik G, Wallaschofski H, Dietz A, Riester A, Reincke M, Allolio B, Lang K, Quack I, Rump LC, Willenberg HS, Beuschlein F, Quinkler M, Hannemann A (2015). "Increased prevalence of diabetes mellitus and the metabolic syndrome in patients with primary aldosteronism of the German Conn's Registry". Eur. J. Endocrinol. 173 (5): 665–75. doi:10.1530/EJE-15-0450. PMID 26311088.
- ↑ 7.0 7.1 Gordon RD (1995). "Primary aldosteronism". J. Endocrinol. Invest. 18 (7): 495–511. doi:10.1007/BF03349761. PMID 9221268.
- ↑ 8.0 8.1 "Prevalence and Characteristics of the Metabolic Syndrome in Primary Aldosteronism | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".
- ↑ Wu VC, Kuo CC, Wang SM, Liu KL, Huang KH, Lin YH, Chu TS, Chang HW, Lin CY, Tsai CT, Lin LY, Chueh SC, Kao TW, Chen YM, Chiang WC, Tsai TJ, Ho YL, Lin SL, Wang WJ, Wu KD (2011). "Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment". J. Hypertens. 29 (9): 1778–86. doi:10.1097/HJH.0b013e3283495cbb. PMID 21738054.
- ↑ Novello M, Catena C, Nadalini E, Colussi GL, Baroselli S, Chiuch A, Lapenna R, Bazzocchi M, Sechi LA (2007). "Renal cysts and hypokalemia in primary aldosteronism: results of long-term follow-up after treatment". J. Hypertens. 25 (7): 1443–50. doi:10.1097/HJH.0b013e328126855b. PMID 17563567.
- ↑ Fallo F, Federspil G, Veglio F, Mulatero P (2007). "The metabolic syndrome in primary aldosteronism". Curr. Hypertens. Rep. 9 (2): 106–11. PMID 17442220.
- ↑ "Metabolic syndrome in primary aldosteronism and essential hypertension: Relationship to adiponectin gene variants - ScienceDirect".
- ↑ Ronconi V, Turchi F, Rilli S, Di Mattia D, Agostinelli L, Boscaro M, Giacchetti G (2010). "Metabolic syndrome in primary aldosteronism and essential hypertension: relationship to adiponectin gene variants". Nutr Metab Cardiovasc Dis. 20 (2): 93–100. doi:10.1016/j.numecd.2009.03.007. PMID 19481913.
- ↑ "Long term outcome of Aldosteronism after target treatments | Scientific Reports".
- ↑ "Treatment strategy and outcome with primary aldosteronism: a nationwide longitudinal cohort based study".
- ↑ Celen O, O'Brien MJ, Melby JC, Beazley RM (1996). "Factors influencing outcome of surgery for primary aldosteronism". Arch Surg. 131 (6): 646–50. PMID 8645073.
- ↑ 17.0 17.1 Stowasser M, Gordon RD, Gunasekera TG, Cowley DC, Ward G, Archibald C, Smithers BM (2003). "High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients". J. Hypertens. 21 (11): 2149–57. doi:10.1097/01.hjh.0000098141.70956.53. PMID 14597859.
- ↑ 18.0 18.1 Stowasser M, Gordon RD (2004). "Primary aldosteronism--careful investigation is essential and rewarding". Mol. Cell. Endocrinol. 217 (1–2): 33–9. doi:10.1016/j.mce.2003.10.006. PMID 15134798.
- ↑ Stowasser M, Gordon RD, Rutherford JC, Nikwan NZ, Daunt N, Slater GJ (2001). "Diagnosis and management of primary aldosteronism". J Renin Angiotensin Aldosterone Syst. 2 (3): 156–69. doi:10.3317/jraas.2001.022. PMID 11881117.
- ↑ Stowasser M, Gartside MG, Gordon RD (1997). "A PCR-based method of screening individuals of all ages, from neonates to the elderly, for familial hyperaldosteronism type I". Aust N Z J Med. 27 (6): 685–90. PMID 9483237.