Primary hyperaldosteronism: diagnosis and treatment. A new look at the problem. According to the materials of the Russian Association of Endocrinologists clinical guidelines for primary hyperaldosteronism diagnosis and treatment

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The article presents the project of the Russian Association of Endocrinologists clinical guidelines for primary hyperaldosteronism (PH) diagnosis and treatment, which provides the modern algorithm for examining patients with PH and also is considered the basic principles of laboratory, instrumental diagnosis and pathogenetic treatment approaches.

About the authors

G. A Melnichenko

Endocrinology research center of the Ministry of Health of the Russian Federation

акад. РАН, д-р мед. наук, проф., дир. ФГБУ ЭНЦ 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11

N. M Platonova

Endocrinology research center of the Ministry of Health of the Russian Federation

Email: doc-platonova@inbox.ru
д-р мед. наук, гл. науч. сотр. отд-ния терапии с группой патологии метаболизма и ожирения ФГБУ ЭНЦ 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11

D. G Beltsevich

Endocrinology research center of the Ministry of Health of the Russian Federation

д-р мед. наук, гл. науч. сотр. отд. хирургии ФГБУ ЭНЦ 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11

M. Yu Yukina

Endocrinology research center of the Ministry of Health of the Russian Federation

канд. мед. наук, ст. науч. сотр. отд. терапевтической эндокринологии, ФГБУ ЭНЦ 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11

N. V Molashenko

Endocrinology research center of the Ministry of Health of the Russian Federation

канд. мед. наук, вед. науч. сотр. отд. терапевтической эндокринологии ФГБУ ЭНЦ 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11

E. A Troshina

Endocrinology research center of the Ministry of Health of the Russian Federation

чл.-кор. РАН, д-р мед. наук, проф., зав. отд-нием терапии с группой патологии метаболизма и ожирения ФГБУ ЭНЦ 117036, Russian Federation, Moscow, ul. Dmitria Ul'ianova, d. 11

References

  1. Milliez P, Girerd X, Plouin P.F et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-8.
  2. Mancia G, Fagard R, Narkiewicz K et al. 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), 2013.
  3. Funder J.W, Carey R.M, 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 (5): 1889-916.
  4. Funder J.W, Carey R.M, Fardella C et al. An Endocrine Society Clinical Practice Guidelines. Case Detection, Diagnosis, and Treatment of Patients with Primary Aldosteronism. J Clin Endocrinol Metab 2008; 93 (9): 3266-81.
  5. Conn J.W. Presidential address. I. Painting background. II. Primary aldosteronism, a new clinical syndrome. J lab Clin Med 1955; 45: 3-17.
  6. Conn J.W, Cohen E.L, Rovner D.R, Nesbit R.M. Normokalemic Primary Aldosteronism.A Detectable Cause of Curable “Essential” Hypertension. Jama 1965; 193: 200-6.
  7. Conn J.W. The Evolution of Primary Aldosteronism 1954-1967. Acedemic Press Inc.
  8. Kaplan N.M. Hypokalemia in the hypertensive patient, with observations on the incidence of primary aldosteronism. Ann Intern Med 1967; 66: 1079-90.
  9. Fishman L.M, Kuchel O, Liddle G.W et al. Incidence of primary aldosteronism uncomplicated “essential” hypertension. A prospective study with elevated aldosterone secretion and suppressed plasma renin activity used as diagnostic criteria. Jama 1968; 205: 497-502.
  10. Berglund G, Andersson O, Wilhelmsen L. Prevalence of primary and secondary hypertension: studies in a random population sample. Br Med J 1976; 2: 554-6.
  11. Tucker R.M, Labarthe D.R. Frequency of surgical treatment for hypertension in adults at the Mayo Clinic from 1973 through 1975. Mayo Clin Proc 1977; 52: 549-5.
  12. Streeten D.H, Tomycz N, Anderson G.H. Reliability of screening methods for the diagnosis of primary aldosteronism. Am J Med 1979; 67: 403-13.
  13. Sinclair A.M, Isles C.G, Brown I et al. Secondary hypertension in a blood pressure clinic. Arch Intern Med 1987; 147: 1289-93.
  14. Andersen G.S, Toftdahl D.B, Lund J.O et al. The incidence rate of phaeochromocytoma and Conn’s syndrome in Denmark, 1977-1981. J Hum Hypertens 1988; 2: 187-9.
  15. Grim C.E, Weinberger M.H, Higgins J.T, Kramer N.J. Diagnosis of secondary forms of hypertension. A comprehensive protocol. Jama 1977; 237: 1331-5.
  16. Gordon R.D, Stowasser M, Tunny T.J et al. High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 1994; 21: 315-8.
  17. Fardella C.E, Mosso L, Gomez-Sanchez C et al. Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology. J Clin Endocrinol Metab 2000; 85: 1863-7.
  18. Lim P.O, Dow E, Brennan G et al. High prevalence of primary aldosteronism in the Tayside hypertension clinic population. J Hum Hypertens 2000; 14: 311-5.
  19. Loh K.C, Koay E.S, Khaw M.C et al. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab 2000; 85: 2854-9.
  20. Mulatero P, Stowasser M, Loh K.C et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clinic Endocrinol Metabo 2004; 89: 1045-50.
  21. Mosso L, Carvajal C, Gonzalez A et al. Primary aldosteronism and hypertensive disease. Hypertension 2003; 42: 161-5.
  22. Schwartz G.L, Turner S.T. Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity. Clin Chem 2005; 51: 386-94.
  23. Hannemann A, Bidlingmaier M, Friedrich N et al. Screening for primary aldosteronism in hypertensive subjects: results from two German epidemiological studies. Eur J Endocrinol 2012; 167: 7-15.
  24. Rossi G.P, 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.
  25. Milliez P, Girerd X, Plouin P.F et al. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-8.
  26. Stowasser M, Sharman J, Leano R et al. Evidence for abnormal left ventricular structure and function in normotensive individuals with familial hyperaldosteronism type I. J Clin Endocrinol and Metab 2005; 90: 5070-6.
  27. Rossi G.P, Cesari M, Cuspidi C et al. Long - term control of arterial hypertension and regression of left ventricular hypertrophy with treatment of primary aldosteronism. Hypertension 2013; 62: 62-9.
  28. Reincke M, Fischer E, Gerum S et al. German Conn’s Registry-Else Kroner-Fresenius-Hyperaldosteronism R. Observational study mortality in treated primary aldosteronism. The German Conn's Registry. Hypertension 2012; 60 (3): 618-24.
  29. Lin Y.H, Lin L.Y, Chen A et al. Adrenalectomy improves increased carotid intima - media thickness and arterial stiffness in patients with aldosterone producing adenoma. Atherosclerosis 2012; 221: 154-9.
  30. Stowasser M, Gordon R.D, Gunasekera T.G et al. High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘nonselective’ screening of hypertensive patients. J Hypertens 2003; 21: 2149-57.
  31. Catena C, Colussi G, Lapenna R et al. Long - term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 2007; 50: 911-8.
  32. Wu V.C, Kuo C.C, Wang S.M et al. Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment. J Hypertens 2011; 29: 1778-86.
  33. Трошина Е.А, Бельцевич Д.Г, Молашенко Н.В. Диагностика и дифференциальная диагностика первичного гиперальдостеронизма. Клин. медицина. 2009; 5: 15-20.
  34. Montori V.M, Schwartz G.L, Chapman A.B et al. Validity of the aldosterone - renin ratio used to screen for primary aldosteronism. Mayo Clin Proc 2001; 76: 877-882.
  35. Stowasser M, Ahmed A.H, Pimenta E et al. Factors affecting the aldosterone/renin ratio. Horm Metab Res 2012; 44: 170-6.
  36. Montori V.M, Schwartz G.L, Chapman A.B et al. Validity of the aldosterone - renin ratio used to screen for primary aldosteronism. Mayo Clin Proc 2001; 76: 877-82.
  37. Fardella C.E, Mosso L, Gomez-Sanchez C et al. Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology. J Clin Endocrinol Metab 2000; 85: 1863-7.
  38. Mosso L, Carvajal C, González A et al. Primary aldosteronism and hypertensive disease. Hypertension 2003; 42 (2): 161-5.
  39. Gallay B.J, Ahmad S, Xu L et al. Screening for primary aldosteronism without discontinuing hypertensive medications: plasma aldosterone - renin ratio. Am J Kidney Dis 2001; 37: 699-705.
  40. Tiu S.C, Choi C.H, Shek C.C et al. 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 2005; 90: 72-8.
  41. Solar M, Malirova E, Ballon M et al. Confirmatory testing in primary aldosteronism: extensive medication switching is not needed in all patients. Eur J Endocrinol 2012; 166: 679-86.
  42. Young W.F. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol 2007; 66: 607-18.
  43. Young W.F. Conventional imaging in adrenocortical carcinoma: update and perspectives. Horm canc 2011; 2: 341-7.
  44. Nwariaku F.E, Miller B.S, Auchus R et al. Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg 2006; 141: 497-502.
  45. Sawka A.M, Young W.F, Thompson G.B et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001; 135: 258-61.
  46. Meyer A, Brabant G, Behrend M. Long - term follow - up after adrenalectomy for primary aldosteronism. World J Surg 2005; 29: 155-9.
  47. Weinberger M.H, Grim C.E, Hollifield J.W et al. Primary aldosteronism: diagnosis, localization, and treatment. Ann Intern Med 1979; 90: 386-95.
  48. Baer L, Sommers S.C, Krakoff L.R et al. Pseudoprimary aldosteronism. An entity distinct from true primary aldosteronism. Circ Res 1970; 27: 203-20.
  49. Priestley J.T, Ferris D.O, Re Mine W.H, Woolner L.B. Primary aldosteronism: surgical management and pathologic findings. Mayo Clin Proc 1968; 43: 761-75.
  50. Young W.F, Stanson A.W, Thompson G.B et al. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004; 136: 1227-35.
  51. Doppman J.L, Gill J.R. Hyperaldosteronism: sampling the adrenal veins. Radiology 1996; 198: 309-12.
  52. Vonend O, Ockenfels N, Gao X et al. Adrenal venous sampling: evaluation of the German Conn’s registry. Hypertension 2011; 57: 990-5.
  53. Mengozzi G, Rossato D, Bertello C et al. Rapid cortisol assay during adrenal vein sampling in patients with primary aldosteronism. Clin Chem 2007; 53: 1968-71.
  54. Auchus R.J, Michaelis C, Wians F.H et al. Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. Ann Surg 2009; 249: 318-21.
  55. Reardon M.A, Angle J.F, Abi-Jaoudeh N et al. Intraprocedural cortisol levels in the evaluation of proper catheter placement in adrenal venous sampling. J Vascular Interv Radiol 2011; 22: 1575-80.
  56. Rossi G.P. Diagnosis and treatment of primary aldosteronism. Endocrinol Metab Clin North Am 2011; 40: 313-32.
  57. Betz M.J, Degenhart C, Fischer E et al. Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates. Eur J Endocrinol 2011; 165: 301-6.
  58. Viste K, Grytaas M.A, Jorstad M.D et al. Efficacy of adrenal venous sampling is increased by point of care cortisol analysis. Endocr Connect 2013; 2: 236-42.
  59. 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.
  60. Lim V, Guo Q, Grant C.S et al. Accuracy of adrenal imaging and adrenal venous sampling in predicting surgical cure of primary aldosteronism. J Clin Endocrinol Metab 2014; 99: 2712-19.
  61. Rossi G.P, Barisa M, Allolio B et al. The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism. J Clin Endocrinol Metab 2012; 97: 1606-14.
  62. Stowaser M et al. Diagnosis and management of primary aldosteronism. J Renin Angiotensin Aldosterone Syst 2001; 2; 156-69.
  63. Rossi G.P, Auchus R.J, 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.
  64. Webb R, Mathur A, Chang R et al. What is the best criterion for the interpretation of adrenal vein sample results in patients with primary hyperaldosteronism? Ann Surg Oncol 2012; 19: 1881-6.
  65. Mc Mahon G.T, Dluhy R.G. Glucocorticoid - remediable aldosteronism. Cardiol Rev 2004; 12: 44-8.
  66. Mulatero P, Tizzani D, Viola A et al. Prevalence and characteristics of familial hyperaldosteronism: the PATOGEN study (Primary Aldosteronism in TOrino-GENetic forms). Hypertension 2011; 58: 797-803.
  67. Dluhy R.G, Anderson B, Harlin B et al. Glucocorticoid - remediable aldosteronism is associated with severe hypertension in early childhood. J Pediatr 2001; 138: 715-20.
  68. Lifton R.P, Dluhy R.G, Powers M et al. A chimaeric 11 beta - hydroxylase/aldosterone synthase gene causes glucocorticoid - remediable aldosteronism and human hypertension. Nature 1992; 355: 262-5.
  69. Jonsson J.R, Klemm S.A, Tunny T.J et al. A new genetic test for familial hyperaldosteronism type I aids in the detection of curable hypertension. Biochem Biophys Res Commun 1995; 207: 565-71.
  70. Fardella C.E, Pinto M, Mosso L et al. Genetic study of patients with dexamethasone - suppressible aldosteronism without the chimeric CYP11B1/CYP11B2 gene. J Clin Endocrinol Metab 2001; 86: 4805-7.
  71. So A, Duffy D.L, Gordon R.D et al. Familial hyperaldosteronism type II is linked to the chromosome 7p22 region but also shows predicted heterogeneity. J Hypertens 2005; 23: 1477-84.
  72. Gordon R.D, Stowasser M, Tunny T.J et al. Clinical and pathological diversity of primary aldosteronism, including a new familial variety. Clin Exp Pharmacol Physiol 1991; 18 (5): 283-6.
  73. Geller D.S, Zhang J, Wisgerhof M.V et al. A novel form of human mendelian hypertension featuring nonglucocorticoid - remediable aldosteronism. J Clin Endocrinol Metab 2008; 93: 3117-23.
  74. Choi M, Scholl U.I, Yue P et al. K channel mutations in adrenal aldosterone - producing adenomas and hereditary hypertension. Science 2011; 331: 768-72.
  75. Scholl U.I, Nelson-Williams C, Yue P et al. Hypertension with or without adrenal hyperplasia due to different inherited mutations in the potassium channel KCNJ5. Proc Natl Acad Sci USA 2012; 109: 2533-8.
  76. Blumenfeld J.D, Sealey J.E, Schlussel Y et al. Diagnosis and treatment of primary hyperaldosteronism. Ann Intern Med 1994; 121: 877-85.
  77. Harris D.A, Au-Yong I, Basnyat P.S et al. Review of surgical management of aldosterone secreting tumours of the adrenal cortex. Eur J Surg Oncol 2003; 29: 467-74.
  78. Rossi E, Regolisti G, Negro A et al. High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives. Am J Hypertens 2002; 15: 896-902.
  79. Young W.F. Jr. Minireview: primary aldosteronism - changing concepts in diagnosis and treatment. Endocrinology 2003; 144: 2208-13.
  80. Lo C.Y, Tam P.C, Kung A.W et al. Primary aldosteronism. Results of surgical treatment. Ann Surg 1996; 224: 125-30.
  81. Proye C.A, Mulliez E.A, Carnaille B.M et al. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism? Surg 1998; 124: 1128-33.
  82. Wu V.C, Kuo C.C, Wang S.M et al. Primary aldosteronism: changes in cystatin C-based kidney filtration, proteinuria, and renal duplex indices with treatment. J Hypertens 2011; 29: 1778-86.
  83. Fourkiotis V, Vonend O, Diederich S et al. Effectiveness of eplerenone or spironolactone treatment in preserving renal function in primary aldosteronism. Eur J Endocrinol 2013; 168: 75-81.
  84. Sawka A.M, Young W.F, Thompson G.B et al. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001; 135: 258-61.
  85. Ishidoya S, Ito A, Sakai K et al. Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 2005; 174 (1): 40-3.
  86. Ghose R.P, Hall P.M, Bravo E.L. The classic presenting signs of primary aldosteronism are hypertension. Br J Clin Pharmacol 1999; 48: 756.
  87. Mattsson C, Young W.F. Primary aldosteronism: diagnostic and treatment strategies. Nat Clin Pract Nephrol 2006; 2 (4): 198-208.
  88. Fischer E, Hanslik G, Pallauf A et al. Prolonged zona glomerulosa insufficiency causing hyperkalemia in primary aldosteronism after adrenalectomy. J Clin Endocrinol Metab 2012; 97: 3965-73.
  89. Weinberger M.H, Grim C.E, Hollifield J.W et al. Primary aldosteronism: diagnosis, localization, and treatment. Ann Intern Med 1979; 90: 386-95.
  90. Baer L, Sommers S.C, Krakoff L.R et al. Pseudo - primary aldosteronism. An entity distinct from true primary aldosteronism. Circ Res 1970; 27: 203-20.
  91. Priestley J.T, Ferris D.O, Re Mine W.H, Woolner L.B. Primary aldosteronism: surgical management and pathologic findings. Mayo Clin Proc 1968; 43: 761-75.
  92. Parthasarathy H.K, Menard J, White W.B et al. A double - blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens 2011; 29 (5): 980-90.
  93. Karagiannis A, Tziomalos K, Papageorgiou A et al. Spironolactone versus eplerenone for the treatment of idiopathic hyperaldosteronism. Expert Opin Pharmacother 2008; 9 (4): 509-15.
  94. Donald T.M. A double - blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens 2011; 29: 980-90.
  95. Whitworth J.A; World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21 (11): 1983-92.
  96. Milliez P, Girerd X, Plouin P.F et al. Evidence for an increased rate of cardiovascular events in patients ith primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-48.

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