Diagnosis and management of primary aldosteronism

JRAAS - Journal of the Renin-Angiotensin-Aldosterone System

Volumn 2, Issue 3, 2001, Pages 156-169

  Stowasser, Michael ^a   Gordon, Richard D ^a   Rutherford, John C ^a   Nikwan, Nik Z ^a   Daunt, Nicholas ^b   Slater, Gregory J ^b  

^a University Department of Medicine   (Australia)

^b GREENSLOPES PRIVATE HOSPITAL   (Australia)

Author keywords

Adrenal venous sampling; Aldosterone renin ratio; Diagnosis; Fludrocortisone suppression test; Prevalence; Primary aldosteronism

Indexed keywords

ALDOSTERONE; RENIN;

BLOOD; HUMAN; HYPERALDOSTERONISM; LABORATORY DIAGNOSIS; MASS SCREENING; METHODOLOGY; PREVALENCE; REVIEW;

ALDOSTERONE; FALSE NEGATIVE REACTIONS; FALSE POSITIVE REACTIONS; HUMANS; HYPERALDOSTERONISM; MASS SCREENING; PREVALENCE; RENIN;

EID: 0035469644     PISSN: 14703203     EISSN: None     Source Type: Journal    
DOI: 10.3317/jraas.2001.022     Document Type: Review

References (111)

1. Conn JW. The evolution of primary aldosteronism: 1954-1967. Harvey Lect 1968;62:257-91.
2. Hiramatsu K, Yamada T, Yukimura Y, Komiya I, Ichikawa K, Ishihara M, et al. A screening test to identify aldosterone-producing adenoma by measuring plasma renin activity. Arch Intern Med 1981;141:1589-93.
3. Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC. High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 1994; 21:315-18.
4. Gordon RD, Ziezak MD, Tunny TJ, Stowasser M, Klemm SA. Evidence that primary aldosteronism may not be uncommon - twelve percent incidence among antihypertensive drug trial volunteers. Clin Exp Pharmacol Pbysiol 1993;20:296-8.
5. Gordon RD, Stowasser M, Klemm SA, Tunny TJ. Primary aldosteronism and other forms of mineralocorticoid hypertension. In: Swales JD (ed.), Textbook of Hypertension. London: Blackwell Scientific; 1994, pp. 865-92.
6. Gordon RD. Mineralocorticoid hypertension. Lancet 1994;344:240-43.
7. Young WF Jr. Primary aldosteronism: a common and curable form of hypertension. Cardiol Rev 1999;7:207-14.
8. Um PO, Dow E, Brennan G, Jung RT, MacDonald TM. High prevalence of primary aldosteronism in the Tayside hypertension clinic population. J Hum Hypertens 2000;14:311-15.
9. Loh K-C, Koay ES, Khaw M-C et al. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab 2000;85:2854-9.
10. Rayner BL, Opie LH, Davidson JS. The aldosterone/renin ratio as a screening test for primary aldosteronism. S Afr Med J 2000;90:394-400.
11. Fardella CE, Mosso L, Gomez-Sanchez C et al. Primary aldosteronism in essential hypertensives: prevalence, biochemical profile and molecular biology. J Clin Endocrinol Metab 2000;85:1863-7.
12. Kaplan NM. Clinical Hypertension. 6th edition. Baltimore: Williams and Wilkins; 1994; pp. 389-408.
13. Ganguly A. Primary aldosteronism. N Engl J Med 1998; 339:1828-34.
14. Conn JW. Plasma renin activity in primary aldosteronism. Importance in differential diagnosis and in research of essential hypertension. J Am Med Assoc 1964;190:222-5.
15. Kaplan NM. Commentary on the incidence of primary aldosteronism. Current estimations based on objective data. Arch Intern Med 1969;123:152-5.
16. Laragh JH, Sealey JE, Sommers SC. Patterns of adrenal secretion and urinary excretion of aldosterone and plasma renin activity in normal and hypertensive subjects. Circ Res 1966;18:158-74.
17. Fishman LM, Küchel O, Liddle GW, Michelakis AM, Gordon RD, Chick WT: Incidence of primary aldosteronism uncomplicated "essential" hypertension. JAMA 1968;205:497-502.
18. Lund JO, Nielsen D, Giese J. Prevalence of primary aldosteronism. Act Med Scand 1981;646 (Suppl):54-7.
19. Berglund G, Andersson O, Wilhelmsen L. Prevalence of primary and secondary hypertension: studies in a random population. Brit Med J 1976;2:554-6.
20. Beevers DG, Nelson CS, Padfield PL, Barlow DH, Duncan S, Greaves DA et al. The prevalence of hypertension in an unselected population, and the frequency of abnormalities of potassium, angiotensin II and aldosterone in hypertensive subjects. Acta Clin Belg 1974;29:276-80.
21. Anderson GS, Toftdahl DB, Lund JO, Strandgaard S, Nielsen PE: The incidence rate of phaeochromocytoma and Conns syndrome in Denmark, 1977-1981. J Hum Hypertens 1988;2:187-9.
22. Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Finn WL, Krek AL. Clinical and pathological diversity of primary aldosteronism including a new familial variety. Clin Exp Pharmacol Physiol 1991;18:283-6.
23. McKenna TJ, Sequeira SJ, Heffernan A, Chambers J, Cunningham S. Diagnosis under random conditions of all disorders of the renin-angiotensin-aldosterone axis, including primary aldosteronism. J Clin Endocrinol Metab 1991;73:952-7.
24. Crane MG, Harris JJ. Effect of aging on renin activity and aldosterone excretion. J Lab Clin Med 1976;87:947-59.
25. Bülhler FR, Laragh JH, Baer L, Vaughan ED, Brunner HR. Propanolol inhibition of renin secretion. A specific approach to diagnosis and treatment of renin-dependent hypertensive diseases. N Engl J Med 1972;287:1209-14.
26. Gordon MS, Williams GH, Hollenberg NK. Renal and adrenal responsiveness to angiotensin II: influence of beta adrenergic blockade. Endocrin Res 1992;18:115-31.
27. Oparil S. Review of therapeutic modalities acting directly via central pathways. Clin Exp Hypertens 1982;4:579-93.
28. Gordon RD. Primary aldosteronism. J Endocrinol Invest 1995;18:495-511.
29. Gordon RD. Diagnostic investigations in primary aldosteronism. In: Zanchetti A (ed.), Clinical Medicine Series on Hypertension. Maidenhead: McGraw-Hill International (UK) Ltd; 2001, pp. 101-14.
30. Fiad TM, Conway JD, Cunningham SK, McKenna TJ. The role of plasma renin activity in evaluating the adequacy of mineralocorticoid replacement in primary adrenal insufficiency. Clin Endocrinol (Oxf). 1996;45:529-34.
31. Mitnick PD, Greenberg A, DeOreo PB, Weiner BM, Coffman TM, Walker BR, Agus ZS, Goldfarb S. Effects of two nonsteroidal anti-inflammatory drugs, indomethacin and oxaprozin, on the kidney. Clin Pharmacol Ther 1980;28:680-9.
32. Gordon RD, Klemm SA, Tunny TJ, Stowasser M. Gordon's syndrome: a sodium-volume dependent form of hypertension with a genetic basis. In: Laragh JH, Brenner B (ed.), Hypertension: Pathophysiology, Diagnosis and Management. New York: Raven Press, 1995;2111-23.
33. Wilson FH, Disse-Nicodeme S, Choate KA, Ishikawa K, Nelson-Willianos C, Desitter I et al. Human hypertension caused by mutations in WNK kinases. Science 2001;293:1107-12.
34. Shimkets RA, Warnock DG, Bositis CM, Nelson-Williams C, Hansson JH, Schambelan M et al. Liddle's syndrome: heritable human hypertension caused by mutations in the β subunit of the epithelial sodium channel. Cell 1994;79:407-14.
35. White PC, Speiser PW. Steroid 11β-hydroxylase deficiency and related disorders. Endocrinol Metab Clin North Am 1994; 23:325-39.
36. Kater CE, Biglieri EG. Disorders of steroid 17α-hydroxylase deficiency. Endocrinol Metab Clin North Am 1994; 23:341-57.
37. Stewart PM. 11β-hydroxysteroid dehydrogenase: implications for clinical medicine. Clin Endocrinol (Oxf) 1996; 44:439-99.
38. Arai K, Chrousos GP. Syndromes of glucocorticoid and mineralocorticoid resistance. Steroids 1995;60:173-9.
39. Geller DS, Farhi A, Pinkerton N, Fradley M, Moritz M, Spitzer A, Meinke G, Tsai FTF, Sigler PB, Lifton RP. Activating mineralocorticoid reseptor mutation in hypertension exacerbated by pregnancy. Science 2000;289:119-23.
40. Irony I, Biglieri EG, Perloff D, Rubinoff H. Pathophysiology of deoxycorticosterone-secreting adrenal tumors. J Clin Endocrinol Metab 1987;65:83640.
41. Walker BR, Campbell JC, Fraser R, Stewart PM, Edwards CRW. Mineralocorticoid excess and inhibition of 11β-hydroxysteroid dehydrogenase in patients with ectopic ACTH. Clin Endocrinol 1992;37:483-92.
42. Brunner HR, Laragh JH, Baer L et al. Essential hypertension: renin and aldosterone, heart attack and stroke. N Engl J Med 1972;286:441-9.
43. Stowasser M. Primary aldosteronism: rare bird or common cause of secondary hypertension? Curr Hypertens Reports 2001;3:230-39.
44. Lim PO, Jung RT, MacDonald TM. Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow-up study. Br J Clin Pharmacol 1999;48:756-60.
45. Lifton RP, Dluhy RG, Powers M et al. A chimaeric 11β-hydroxylase/aldosterone synthase gene causes glucocorticoid-remediable aldosteronism and human hypertension. Nature 1992;355:262-5.
46. Jonsson JR, Klemm SA, Tunny TJ, Stowasser M, Gordon RD. A new genetic test for Familial Hyperaldosteronism Type I aids in the detection of curable hypertension. Biochem Biophys Res Comm 1995;207:565-71.
47. Gordon RD, Stowasser M. Familial forms broaden horizons in primary aldosteronism. Trends Endocrinol Metab 1998; 9:220-7.
48. Stowasser M, Gordon RD, Tunny TJ, Klemm SA, Finn WL, Krek AL. Primary aldosteronism - implications of a new familial variety. J Hypertens 1991;9(suppl 6):S264-S265.
49. Weber KT, Brilla CG. Pathological hypertrophy and cardiac interstitium: fibrosis and renin-angiotensin-aldosterone system. Circulation 1991;83:1849-65.
50. Rossi GP, Sacchetto A, Pavan E et al. Remodeling of the left ventricle in primary aldosteronism due to Conn's adenoma. Circulation 1997;95:1471-8.
51. Pitt B, Zannad F, Remme WJ et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999;341:709-17.
52. Manhem P, Hokfelt B. Prolonged clonidine treatment: catecholamines, renin activity and aldosterone following exercise in hypertensives. Acta Med Scand 1981;209:253-60.
53. Cappuccio FP, Markandu ND, Sagnella GA, Singer DR, Buckley MG, Miller MA, MacGregor GA. Effects of amlodipine on urinary sodium excretion, renin-angiotensin-aldosterone system, atrial natriuretic peptide and blood pressure in essential hypertension. J Hum Hypertens 1991;5:115-19.
54. Gordon RD, Wolfe LK, Island DP, Liddle GW. A diurnal rhythm in plasma renin activity in man. J Clin Invest 1966; 43:1587-92.
55. Michelakis AM, Horton R. The relationship between plasma renin and aldosterone in normal man. Circ Res 1970;26 and 27(Suppl I):I-185-I-202.
56. Fiad TM, Cunningham SK, Hayes FJ, McKenna TJ. Effects of nifedipine treatment on the renin-angiotensin-aldosterone axis. J Clin Endocrinol Metab 1997;82:457-60.
57. Brown MJ, Hopper RV. Calcium-channel blockade can mask the diagnosis of Conn's syndrome. Postgrad Med J 1999; 75:235-6.
58. Stowasser M, Gordon RD, Klemm SA, Tunny TJ. Renin-aldosterone response to dexamethasone in glucocorticoid-suppressible hyperaldosteronism is altered by coexistent renal artery stenosis. J Clin Endocrinol Metab 1993;77:800-04.
59. Gordon RD, Tunny TJ. Aldosterone-producing adenoma (A-P-A): effect of pregnancy. Clin Exp Hypertens Theory Pract 1982;A4:1685-93.
60. Murphy BF, Whitworth JA, Kincaid-Smith P. Malignant hypertension due to an aldosterone producing adrenal adenoma. Clin Exp Hypertens Theory Pract 1985;A7:939-50.
61. Young WF Jr. Primary aldosteronism: update on diagnosis and treatment. The Endocrinologist 1997;7:213-21.
62. Nakamura T, Ichikawa S, Sakamaki T, Sato K, Kogure M, Tajima Y, Kato T, Murta K. Role of atrial natriuretic peptide in mineralocorticoid escape phenomenon in patients with primary aldosteronism. Proc Soc Exp Biol Med 1987;185:448-54.
63. Lyons DF, Kem DC, Brown RD et al. Single dose captopril as a diagnostic test for primary aldosteronism. J Clin Endocrinol Metab 1983;57:892-6.
64. Sica DA, Hollenberg NK. The renal profile of eprosartan. Phrmacotherapy 1999;19:86S-94S.
65. Guthrie GP Jr., McAllister RG Jr., Kotchen TA. Effects of intravenous and oral verapamil upon pressor and adrenal steroidogenic responses in normal man. J Clin Endocrinol Metab 1983;57:339-43.
66. Leenen FH, Smith DL, Farkas RM, Reeves RA, Marquez-Julio A. Vasodilators and regression of left ventricular hypertrophy. Hydralazine versus prazosin in hypertensive humans. Am J Med 1987;82:969-78.
67. Gordon RD, Gomez-Sanchez CE, Hamlet SM, Tunny TJ, Klemm SA. Angiotensin-responsive aldosterone-producing adenoma masquerades as idiopathic hyperaldosteronism (IHA: adrenal hyperplasia) or low-renin essential hypertension. J Hypertens 1987;5[Suppl 5]:S103-S106.
68. Padfield PL, Allison MEM, Brown JJ, Ferriss JD, Fraser R, Lever AF, Luke RG, Robertson JIS. Response of plasma aldosterone to fludrocortisone in primary aldosteronism and other forms of hypertension. Clin Endocrinol 1975;4:493-500.
69. Lund JO, Nielsen MD. Fludrocortisone suppression test In normal subjects, in patients with essential hypertension and in patients with various forms of aldosteronism. Acta Endocrinol 1980;93:100-07.
70. Vaughan NJA, Jowett TP, Slater JDH, Wiggins RC, Lightman SL, Ma JTC, Payne NN. The diagnosis of primary aldosteronism. Lancet 1981;1:120-25.
71. Litchfield WR, Dluhy RG. Primary aldosteronism. Endocrinol. Metab Clin North Am 1995;24:593-612.
72. Holland OB, Brown H, Kuhnert LV, Fairchild C, Risk M, Gomez-Sanchez CE. Further evaluation of saline infusion for the diagnosis of primary aldosteronism. Hypertension 1984; 6:717-23.
73. Kem DC, Weinberger MH, Mayes DM, Nugent CA. Saline suppression of plasma aldosterone in hypertension. Arch Intern Med 1971;128:380-6
74. Soma R, Miyamori, Nakagawa A et al. Possible association of aldosterone producing adenoma and non-functioning adrenal tumour. J Endocrinol Invest 1989;12:183-6.
75. McAlister FA, Lewanczuk RZ. Primary hyperaldosteronism and adrenal incidentaloma: an argument for physiological testing before adrenalectomy. Can J Surg 1998;41:299-305.
76. Sutherland DJA, Ruse JL, Laidlaw JC. Hypertension, increased aldosterone secretion and low plasma renin activity relieved by dexamethasone. Can Med Assoc J 1966;95:1109-19.
77. Giebink GS, Gotlin RW, Biglieri EG, Katz FH. A kindred with familial glucocorticoid-suppressible aldosteronism. J Clin Endocrinol Metab 1973;36:715-23.
78. Stowasser M, Gartside MG, Gordon RD. A PCR-based method of screening individuals of all ages, from neonates to the elderly, for Familial Hyperaldosteronism Type I. Anst NZ J Med 1997;27:685-90.
79. Stowasser M, Gordon RD. Primary aldosteronism: learning from the study of familial varieties. J Hypertens 2000;18:1165-76.
80. Stowasser M, Tunny TJ, Gartside M, Taylor WL, Gordon RD. In Familial Hyperaldosteronism Type I, hybrid gene-induced aldosterone production dominates that induced by wild type genes. J Clin Endocrinol Metab 1997;82:3670-76.
81. Connell JMC, Kenyon CJ, Corrie JET, Fraser R, Watt R, Lever AF. Dexamethasone-suppressible hyperaldosteronism: adrenal transitional cell hyperplasia? Hypertension 1986;8:669-76.
82. Gill JR, Bartter FC. Overproduction of sodium-retaining steroids by the zona glomerulosa is adrenocorticotropin-dependent and mediates hypertension in dexamethasone-suppressible aldosteronism. J Clin Endocrinol Metab 1981; 53:331-7.
83. Stowasser M, Bachmann AW, Huggard FJ, Rossetti TR, Gordon RD. Treatment of familial hyperaldosteronism type I: only partial suppression of hybrid gene required to correct hypertension. J Clin Endocrinol Metab 2000;85:3313-18.
84. Stowasser M, Bachmann AW, Jonsson JR, Tunny TJ, Klemm SA, Gordon RD. Clinical, biochemical and genetic approaches to the detection of Familial Hyperaldosteronism Type I. J Hypertens 1995;13:1610-13.
85. Mulatero P, Veglio F, Pilon C et al. Diagnosis of glucocorticoid-remediable aldosteronism in primary aldosteronism: aldosterone response to dexamethasone and long polymerase chain reaction for chimeric gene. J Clin Endocrinol Metab 1998;83:2573-75.
86. Litchfield WR, New MI, Coolidge C, Lifton RP, Dluhy RG. Evaluation of the dexamethasone suppression test for the diagnosis of glucocorticoid-remediable aldosteronism. J Clin Endocrinol Metab 1997;82:3570-3.
87. Stowasser M, Bachmann AW, Huggard PJ, Rossetti TR, Gordon RD. Severity of hypertension in familial hyperaldosteronism type I: relationship to gender and to degree of biochemical disturbance. J Clin Endocrinol Metab 2000;85:2160-66.
88. Kem DC, Weinberger MH, Higgins JR, Kramer NJ, Gomez-Sanchez C, Holland OB. Plasma aldosterone response to ACTH in primary aldosteronism and in patients with low renin hypertension. J Clin Endocrinol Metab 1978;46:552-60.
89. Doppman JL, Gill JR. Hyperaldosteronism: sampling the adrenal veins. Radiology 1996;198:309-12.
90. Stowasser M, Gordon RD. Prevalence and diagnostic workup of primary aldosteronism. Nephrology 2001;6:119-26.
91. Woods JJ, Sampson ML, Ruddel ME, Remaley AT. Rapid intraoperative cortisol assay: design and utility for localizing adrenal tumors by venous sampling. Clin Biochem 2000; 33:501-03.
92. Neville AM, O'Hare MJ. Histopathology of the human adrenal cortex. Clin Endocrinol Metab 1985;14:791-820.
93. Ganguly AG, Melada GA, Luetscher JA, Dowdy AJ. Control of plasma aldosterone in primary aldosteronism: distinction between adenoma and hyperplasia. J Clin Endocrinol Metab 1973;37:765-75.
94. Ganguly A, Grim CE, Weinberger MH. Anomalous postural aldosterone response in glucocorticoid-suppressible hyperaldosteronism. N Engl J Med 1981;305:991-3.
95. Ulick S, Chu MD. Hypersecretion of a new corticosteroid, 18-hydroxycortisol in two types of adrenocortical hypertension. Clin Exp Hypertens 1982;A4:1771-7.
96. Ulick S, Chu MD, Land M. Biosynthesis of 18-oxocortisol by aldosterone-producing adrenal tissue. J Biol Chem 1983; 258:5498-5502.
97. Gomez-Sanchez CE, Montgomery M, Ganguly A, Holland OB, Gomez-Sanchez EP, Grim CE, Weinberger MH. Elevated urinary excretion of 18-oxocortisol in glucocorticoid-suppressible aldosteronism. J Clin Endocrinol Metab 1984;59:1022-24.
98. Gordon RD, Hamlet SM, Tunny TJ, Gomez-Sanchez CE, Jayasinghe LS. Distinguishing aldosterone-producing adenoma from other forms of hyperaldosteronism and lateralizing the tumour pre-operatively. Clin Exp Pharmacol Physiol 1986; 13:325-8.
99. Torpy DJ, Gordon RD, Stratakis CA. Linkage analysis of familial hyperaldosteronism type II - absence of linkage of the gene encoding the angiotensin II receptor type 1. J Clin Endocrinol Metab 1998;83:1046.
100. Torpy DJ, Gordon RD, Lin J-P et al. Familial hyperaldosteronism type-II: description of a large kindred and exclusion of the aldosterone synthase (CYP11B2) gene. J Clin Endocrinol Metab 1998;83:3214-18.
101. Lafferty AR, Torpy DJ, Stowasser M et al. A. novel locus for low-renin hypertension: familial hyperaldosteronism type II maps to chromosome 7 (7p22). J Med Genet 2000;37:831-5.
102. Gordon RD. Mineralocorticoid excess syndromes. In: Margioris AN, Chrousos GP (eds.), Contemporary Endocrinology: Adrenal Disorders. Humana Press, New Jersey. 2000;355-77.
103. Stowasser M, Klemm SA, Tunny TJ, Storie WJ, Rutherford JC, Gordon RD. Response to unilateral adrenalectomy for aldosterone-producing adenoma - effect of angiotensin responsiveness and potassium levels. Clin Exp Pharmacol Physiol 1994; 21:319-22.
104. Rutherford JC, Taylor WL, Stowasser M, Gordon R. Success of surgery in primary aldosteronism judged by residual autonomous aldosterone production. World J Surg 1998; 22:1243-5.
105. Rutherford JC, Stowasser M, Tunny TJ, Klemm SA, Gordon RD. Laparoscopic adrenalectomy. World J Snrg 1996;20:758-60.
106. Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A. Laparoscopic adrenalectomy. Lessons learned from 100 consecutive procedures. Ann Surg 1997;26:238-47.
107. Gordon RD, Rutherford JC, Stowasser M. Primary aldosteronism: are we diagnosing and operating on too few patients? World J Surg 2001;25:941-7.
108. Kaplan NM. Cautions over the current epidemic of primary aldosteronism. Lancet 2001;357:953-4.
109. Delyani JA. Mineralocorticoid receptor antagonists: the evolution of utility and pharmacology. Kidney Int 2000; 57:1408-11.
110. Walker BR, Edwards CRW. Dexamethasone-suppressihle hypertension. Endocrinologist 1993;3:87-97.
111. White PC. Inherited forms of mineralocorticoid hypertension. Hypertension 1996;28:927-36.