Efficacy and safety of spironolactone in mono-therapy versus low dose spironolactone in combined-therapy for the treatment of idiopathic hyperaldosteronism / 中华内分泌代谢杂志

Objective The aim of this study was to compare the efficacy and safety of spironolactone in mono-therapy versus low dose spironolactone in combined-therapy for the treatment of idiopathic hyperaldosteronism (IHA). Methods This was a prospective and randomized study. After 2 weeks wash out period, 48 patients confirmed IHA were assigned to either spironolactone mono-therapy or low dose spironolactone combined-therapy groups. All patients underwent adrenal venous sampling and showed no lateralization. The primary outcome was the percentage of patients with blood pressure<140/90 mmHg(1 mmHg＝0.133 kPa) at 16 weeks. The other observatory parameters were: the occurrence of gynecomastia, renal insufficiency, and hyperkalemia. Results At the end of 16 weeks, the patients′blood pressure were normalized in 17 out of 24 patients(70.8%) in mono-therapy group and in 23 out of 24 patients ( 95. 8%) in combined-therapy group ( P<0. 05). There was no hyperkalemia in both groups. 2 patients and 5 patients in mono-therapy group were observed renal insufficiency and gynecomastia respectively, while no patients in combined-therapy group presented with those side effects. Conclusion Low dose spironolactone combined-therapy group is more effective to control blood pressure and hypokalemia without increase the occurrence of renal insufficiency or gynecomastia.

Identification of the etiology of primary aldosteronism with adrenal vein sampling in patients with equivocal imaging findings / 中华内分泌代谢杂志

A group of 19 referred hypertensive patients were diagnosed to have primary aldosteronism(PA) with inconclusive computed tomography scan results.Adrenal vein sarmpling (AVS) was performed in all patients.AVS was successful in 16 cases but failed in 3 cases.According to the results of AVS and postoperative pathology,8 cases were diagnosed as aldosterone-producing adenoma (APA) and unilateral adrenal hyperplasia (UAH),and the other 8 cases were diagnosed as idiopathic hyperaldosteronism (IHA).In conclusion,AVS is one of the most crucial methods in typing diagnosis of PA.

Cardiac structural changes in idiopathic hyperaldosteronism and treatment with spironolactone / 第二军医大学学报

Objective: To analyze the cardiac structural changes of patients with primary aldosteronism (PA), to observe cardiac structural remodelling of idiopathic hyperaldosteronism (IHA) patients after treatment with spironolactone, and to discuss the association of the remodeling with blood pressure and blood aldosterone levels. Methods: A total of 172 PA patients were taken as experimental group and 100 patients with essential hypertension (EH) served as control group. The clinical data of patients in the two groups were collected. The general information, biochemical data, hormone levels and echocardiographic parameters, including the aortic opening (AO), left atrium diameter (LAd), diastolic left ventricular diameter (DVLd), systolic left ventricular diameter (SVLd), interventricular spetal thickness (IVST), left ventricular posterior wall thickness (LVPW), and left ventricular mass index(LVMI) were compared between the two groups. Thirty-eight patients with IHA were followed up, and changes of the above-mentioned echocardiographic parameters were observed. We also analyzed the relationship between the parameters of cardiac structural remodelling with the blood pressure and plasma aldosterone levels. Results: The AO, LAd, DVLd, SVLd, IVST, LVPW, and LVMI in PA group were significantly increased compared with those in EH group (P<0.01), and these parameters were positively correlated with the systolic pressure (P<0.05). The cardiac hypertrophy parameters, such as IVST and LVMI, were significantly improved after treatment with spironolactone(P< 0.01); and the cardiac volume parameters, such as AO, LAd, DVLd, and SVLd, had no noticeable changes, and were correlated with plasma aldosterone level. Conclusion: PA patients have a more severe cardiac remodeling compared with EH patients, which has a closer relationship with systolic blood pressure. Treatment with spironolactone can ameliorate the cardiac structural changes, especially the cardiac hypertrophy, in IHA patients.

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.

A case of idiopathic hyperaldosteronism vs. bilateral aldosterone producing adenoma / 대한내과학회지

In most cases, primary aldosteronism is due to a unilateral adrenal adenoma or bilateral hyperplasia of the adrenal cortex. However, a few bilateral adrenal tumors have also been reported in primary aldosteronism. In such cases, it is important to differentiate bilateral aldosterone-producing adenomas from bilateral adrenal hyperplasia so as to develop the optimal treatment plan. We report a case of idiopathic hyperaldosteronism due to bilateral adrenal hyperplasia that could have been misdiagnosed as a bilateral aldosterone-producing adenoma. An adrenal CT scan revealed bilateral adrenal tumors (1.5 cm [right] and 3.6 cm [left] in diameter). Idiopathic hyperaldosteronism was properly diagnosed using a posture test and selective adrenal venous sampling.

Clinical analysis of primary hyperaldosteronism and predictive value of preoperative test for primary hyperaldosteronism / 中国医师进修杂志

Objective To evaluate the clinical feature of the aldosterone-producing adenoma(APA) and idiopathic hyperaldosteronism(IHA)in primary hyperaldosteronism.Methods Retrospectively analyzed clinical feaures of 76 patients with APA and 17 patients with IHA.Results (1)Compared with the patients with IHA,the patients with APA had higher plasma and urinary aldosterone,lower serum potassium.(2)Furosemide provocation test(FPT)in 48 patients with APA and 14 patients with IHA were carried out.It was found that the plasma aldosterone after FPT was increased or no changed in 27 patients with adenoma,and increased in the others.It was increased in all IHA patients.(3)The diagnostic accuracy rate of CT was 84.2% in 88 patients with computed tomography imaging(CT).Conclusion The anomalies of laboratory in patients with APA are more evidence than those of IHA.The results of FPT are overlapped in a considerable amount of APA and IHA.Now those with elevation of serum aldosterone after the FPT can not exclude the adenoma.The diagnostic accuracy rate can be improved according to FPT and CT.

Role of imaging diagnosis in surgical treatment of primary aldosteronism / 上海第二医科大学学报

Objective To evaluate the role of imaging diagnosis in surgical treatment of primary aldosteronism(PA). MethodsFrom Jan 1995 to Dec 2004,245 patients with PA were hospitalized in our hospital.Before the operations,all the patients underwent B-ultrasonography and CT scaning,240 received intravenous pyelography and 75 MRI.The preoperative imaging diagnosis were compared with the findings during the operations and postoperative pathologic results. Results Compared with the findings during the operations,the accuracy rates of localized diagnosis for PA with B-ultrasonography,CT scanning and MRI were 92.7%,98.2% and 90.4%,respectively.Compared with the postoperative pathologic results,the accuracy rates of qualitative diagnosis for aldosterone-producing adenoma(APA) with B-ultrasonography,CT scanning and MRI were 83.0%,90.7% and 72.2%,respectively. Conclusion The comprehensive imaging data are helpful in the localized diagnosis of PA.Correct preoperative qualitative diagnosis of APA is the key step for the surgical treatment for PA.

Imaging diagnosis of primary aldosteronism / 中国实用内科杂志

Primary aldosteronism (PA) is a common cause for secondary hypertension.The diagnosis of PA is based on clinical and biochemical features of suspects.Imaging diagnosis plays an important role in differential diagnosis between the two main causes of PA:aldosterone-producing adenoma and idiopathic hyperaldosteronism.CT is especially important for the localization and differential diagnosis of PA.Adrenal venous sampling is invasive,but it is the most reliable approach for determining the causes of PA.