Diagnosis, treatment and progress of primary aldosteronism in China / 中华内分泌代谢杂志

Primary aldosteronism is an important cause of secondary hypertension with the prevalence of 10%-20%in hypertensive patients. Compared with essential hypertension, primary aldosteronism patients have more cardiovascular and cerebrovascular complications. In this article, we will make a discussion on the development and current situation of primary aldosteronism by means of its prevalence, case detection, case confirmation, subtype classification, treatment and basic research.

The usage of computed tomography and serum potassium in determining the subtypes of primary aldosteronism / 中华内分泌代谢杂志

A article, entitled " Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism" published in JCEM in March, 2018, was translated into Chinese here after obtaining the copyright [Umakoshi H, Tsuiki M, Takeda Y, et al. J Clin Endocrinol Metab,2018,103(3):900-908]. This is a multi-institutional retrospective cohort study and its aim was to develop an algorithm for adrenal venous sampling (AVS) based on subtype prediction by computed tomography ( CT) and serum potassium. A total of 1 591 patients with primary aldosteronism ( PA) were classified into four groups according to CT findings and potassium status. Subtype diagnosis of PA was determined by AVS. The prevalence and odds ratio for unilateral hyperaldosteronism on AVS were as follows: bilateral normal on CT with normokalemia, 6.2%(reference); unilateral disease on CT with normokalemia, 23.8%and OR＝4.8 (95%CI 3.1-7.2); bilateral normal on CT with hypokalemia, 38.1%and OR＝9.4 (95%CI 6.2-14.1), and unilateral disease on CT with hypokalemia, 70.6% and OR＝36.4 (95%CI 24.7-53.5). Patients with PA with bilateral normal results on CT and normokalemia likely have a low prior probability of a lateralized form of AVS and could be treated medically, whereas those with unilateral disease on CT and hypokalemia have a high probability of a lateralized form of AVS.

Factors Associated with Resolution of Hypertension after Adrenalectomy in Patients with Primary Aldosteronism

BACKGROUND: The aim of this study was to investigate the factors associated with resolution of hypertension after adrenalectomy in patients with primary aldosteronism. A secondary aim was to describe our use of the contralateral ratio in adrenal venous sampling (AVS) in the setting of suboptimal successful cannulation rates. METHODS: A retrospective review of patients who underwent AVS followed by unilateral adrenalectomy for primary aldosteronism was performed. RESULTS: Complete resolution of hypertension and hypokalemia was seen in 17 of 40 patients (42.5%), while a clinical improvement in hypertension was seen in 38 of 40 (95%). Shorter duration of hypertension, mean aldosteronoma resolution score (ARS), and a high ARS of 3 to 5 were associated with resolution of hypertension after adrenalectomy (P=0.02, P=0.02, and P=0.004, respectively). Of the individual components of ARS, only a duration of hypertension of ≤6 years was associated with resolution of hypertension after adrenalectomy (P=0.03). CONCLUSION: A shorter duration of hypertension was significantly associated with resolution of hypertension after adrenalectomy in patients with primary aldosteronism.

Diagnosis and treatment of Cushing's syndrome caused by bilateral solitary adrenal neoplasma / 中华内分泌代谢杂志

_ Objective_ To evaluate the efficacy of unilateral subtotal adrenalectomy in the treatment of bilateral adrenal solitary neoplasma causing Cushing's syndrome and to elaborate the therapeutic principle. Methods From 2007 to 2013, a total of ten patients were diagnosed with Cushing's syndrome caused by bilateral solitary adrenal neoplasma. We compared patients'clinical symptoms, hormone profiles, biochemical and metabolic parameters, and imaging data before and after the surgery. Five of them chose the optimal neoplasma based on the lateralization ratio of adrenal venous sampling result and the other 5 patients chose the optimal neoplasma based on the diameter of the mass reflected by the computed tomography result and were then operated. Results After the unilateral subtotal adrenalectomy,the24-hour urinary free cortisol decreased significantly(P<0.05)and the midnight serum cortisol level also significantly reduced(P<0. 01). Plasma adrenocorticotropic hormone level increased significantly(P<0. 01). Nine patients of them did not need contralateral adrenalectomy and one patient received contralateral adrelectomy because of the remnant of Cushingnoid symptoms. Conclusion Unilateral subtotal adrenalectomy is an effective and safe way to treat Cushing's syndrome caused by bilateral solitary neoplasma.

Role of adrenal venous sampling in differential diagnosis of subtypes in primary aldosteronism / 国际生物医学工程杂志

Objective To evaluate the role of adrenal venons sampling (AVS) in differential diagnosis of subtypes in primary aldosteronism.Methods Twenty-two patients diagnosed as primary aldosteronism in the Third Central Hospital of Tianjin from November 201 1 to July 2014, were undergone AVS for measurement of plasma aldosterone and cortisol levels in each adrenal vein and infrarenal inferior vena cava.The data were compared with the results of the thin slice incremental scanning in adrenal and postoperative pathologic diagnosis.Other 8 patients, whose screening test and confirmed diagnosis did not support the primary aldosteronism, with nodule larger than 4 cm pathologically confirmed as non-functioning adrenal adenoma, were also recruited.Results Among all the 22 patients with primary aldosteronism, the incidence rate of hypertention was 95.4％, and the incidence of hypokalemia was 81.8％.Compared with idiopathic hyperaldosteronism patients, the patients with aldosterone producing adenoma had higher blood pressure and aldosterone level in plasma, but lower plasma potassium, while the clinical and biochemical index of the non-functioning adrenal adenoma group were within the normal range.The overall accuracy rate of adrenal CT in the diagnosis of subtypes of primary aldosteronism was 77.27％ (17/22), and the accuracy rates were 78.95％ (15/19) in aldosterone producing adenoma and 66.7％ (2/3) in idiopathic hyperaldosteronism, respectively.The accuracy rate of AVS was 100％ with the ratio of aldosterone to cortisol as the criterion.Conclusions Misdiagnose may occur when using CT scan only to differentially diagnose primary aldosteronism.Compared with CT imaging of the adrenal glands, AVS has higher coincidence rate and is an elective approach to establish the subtype diagnosis of questionable primary aldosteronism.

Primary Aldosteronism / 대한내과학회지

Primary aldosteronism (PA) is characterized by inappropriately high production of aldosterone relatively autonomous from the renin-angiotensin system and no suppression by sodium loading. The prevalence of PA is estimated more than 10% among nonseleted hypertensive patients. PA is clinically very important since patients with PA have higher cardiovascular morbidity and mortality than age- and sex-matched patients with essential hypertension and the same degree of blood pressure elevation. The ratio of plasma aldosterone concentration to plasma renin activity (ARR) has been generally accepted as a first-line screening test. ARR might be affected by patient age, anti-hypertensive drugs, posture and menstrual cycles. Once the ARR is measured, confirmative test should be performed. Although a gold standard confirmative test for PA is not yet identified, intravenous saline loading test is widely used. Adrenal venous sampling (AVS) is a gold standard for differentiation of unilateral from bilateral forms of PA. Since adrenal CT imaging has limitations to accurate diagnosis of PA, AVS is recommended for all patients who wish to pursue surgical treatment. Although unilateral laparoscopic adernalectomy is the optimal treatment for patients with aldosterone producing adenoma or unilateral hyperplasia, strong evidence linking adernalectomy with improved quality of life, morbidity or mortality is not available. Mneralocorticoid receptor antagonists, spironolactone or eplerenone, are recommended for pharmacologic therapy of PA.

Differential diagnosis of subtypes in primary aldosteronism / 中华内分泌代谢杂志

Objective To evaluate the tests in differential diagnosis of subtypes in patients with primary aldosteronism. Methods Fifty-seven patients in the past 7 years chnically diagnosed as primary aldosteronism [22cases of aldosterone-producing adenoma (APA), 26 idiopathic hyperaldosteronism (IHA) and 9 primary adrenal hyperplasia (PAH)] were selected. The plasma potassium, basic and upright plasma renin activity, plasma and urinary aldosterone were determined. 19 patients with essential hypertension served as control. All patients with primary aldosteronism underwent adrenal CT, postural stimuhtion test (PST) and adrenal venous sampling (AVS) to differentiate the subtypes. The clinical and laboratory data were followed up during survey. Results (1) The patients with APA had higher blood pressure and aldosterone level in plasma or urine, but lower plasma potassium and plasma renin activity than those with IHA. In PAH group, these parameters were in the ranges between APA group and IHA group. For the diagnosis of APA, IHA and PAH, the coincidences were 86.4%, 73.1% and 22.2% by adrenal CT, 86.4%, 80.8% and 77.8% by the ratio of aldosterone in both sides of AVS and 95.5%,92.3% and 100.0% by the ratio of aldosterone to cortisol in beth sides, respectively. (2) The plasmaaldosterone, systohc and diastolic blood pressure were decreased after operation in the patients of APA and PAH,and no significant changes were found in patients with IHA. Conclusion The abnormal laboratory findings in patients with APA axe more evident than those in IHA. The result of PST is overlapping considerably in cases ofAPA and IHA. Adrenal venous samphng yields a high coincidence, which should be done in patients with negative CT scanning. The ratio of aldosterone to eortisol in AVS is more reliable. The clinical and laboratory data,especially plasma potassium will be improved after operation in patients with APA and PAH. But there is no change in patients with IHA during the follow-up period.

Primary hyperaldosteronism:not an unusual reason for hypertension / 中国实用内科杂志

Recently,with the improvement in recognition and diagnosis technology for primary hyperaldosteronism(PA),the incidence of PA has risen markedly.As a cause of hypertension,PA should be diagnosed based on correct clinical practice.This article discusses the screening test,confirmation tests and subtype classification of PA.

Clinical guidelines for diagnosis and treatment of primary hyperaldosteronism / 中国实用内科杂志

Primary hyperaldosteronism(PA),with a high prevalence of 10%~20% in normal population,is an important cause of secondary hypertension.Compared with essential hypertension patients,PA patients have higher risks for cardiovascular and cerebrovascular complications.Early diagnosis of primary hyperaldosteronism is of great importance.This article is to discuss the prevalence,diagnosis,case confirmation,subtype classification and treatment of primary hyperaldosteronism.

Adrenal venous sampling in the differential diagnosis of primary aldosteronism / 中国实用内科杂志

Objective To study the value of adrenal venous sampling (AVS) in the differential diagnosis of primary aldosteronism (PA).Methods Fourteen patients (11 adenoma and 3 adrenal hyperplasia) clinically diagnosed as PA were examined with AVS for measurement of plasma aldosterone and cortisol levels.Selectivity of AVS was assessed by the aldosterone level in each adrenal vein and in the infrarenal inferior vena cava plasma.The data were compared with CT and postoperative pathologic result.Results The diagnosis of adenoma by AVS in 9 (9/11) cases was in accordance with the postoperative pathologic findings.The diagnosis of hyperplasia by AVS in all 3 cases was in accordance with CT scanning result.Conclusion AVS should be selected to distinguish the PA without overt occupational lesion in CT scanning.

Primary Aldosteronism Due to Aldosterone Producing Adenama in the Presence of Contralateral Nonfunctioning Adenama / 대한내분비학회지

Primary aldosteronism is in most cases due either to a unilateral adrenal adenama or to a bilateral hyperplasia of the adrenal cortex. But, a few of bilateral adrena1 tumors in primary aldosteronism also have been reported. In these cases, it is important to differentiate the bilateral aldosterone producing adenomas from the unilateral aldosteronoma in the presence of a contralateral nonhmctioning adenoma for marking a treatment plan. We report a case of primary aldosteronism due to a unilateral aldosteronoma in the presence of a contralateral nonfunctioning adenoma. Abdominal CT sean revealed bilateral adrenal tumors, of which the functioning one was successfully localized using adrenal scintigraphy and selective adrenal venous sampling.