The Th17/Treg imbalance in patients with primary hyperaldosteronism and resistant hypertension

Abstract The underlying cause of resistant hypertension after adrenalectomy for primary hyperaldosteronism remains controversial. The objective of this study was to identify preoperative factors predictive of resistant hypertension in patients after undergoing retroperitoneoscopic adrenalectomy. Between 2003 and 2009, 124 patients with unilateral aldosterone-producing adenoma or unilateral adrenal hyperplasia underwent retroperitoneoscopic adrenalectomy at our institution. Clinical and biochemical data were reviewed retrospectively at baseline and after a median follow-up time of 59.2 ± 37.2 months. Adrenalectomy cured hypertension in 68 patients (54.8%) and 43 (34.8%) had persistent hypertension that was much easier to control after surgery, whereas 13 patients (10.4%) had continued hypertension and poor blood pressure control. Multivariate regression analysis revealed that the main determinants of postoperative cure were duration of hypertension less than 5 years [odds ratio (OR): 6.515, 95% confidence interval (CI) 2.278–10.293), number of antihypertensive medications ≤2 (OR: 2.939, 95% CI 1.254–5.235), preoperative response to spironolactone (OR: 3.405, 95% CI 1.681–6.985), the TT genotype of the CYP11B2 gene (344 C/T) (OR: 2.765, 95% CI 1.221–4.986), and the presence of adenoma rather than hyperplasia (OR: 5.274, 95% CI 2.150–8.141). The main determinants of surgical cure or control of hypertension in patients with primary hyperaldosteronism were duration of hypertension, number of antihypertensive medications, preoperative response to spironolactone, the presence of adenoma, and CYP11B2 (344 C/T) genotype. Consideration of these factors may help in the evaluation of patients for surgery and for the identification of patients with continued postoperative hypertension that may require more long-term monitoring and treatment.

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Abstract 16932: Primary Hyperaldosteronism And Resistant Hypertension In Pregnancy

Circulation ◽

10.1161/circ.144.suppl_2.16932 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Agnes Koczo ◽

Malamo E Countouris ◽

Alisse Hauspurg ◽

Kathryn Berlacher

Keyword(s):

Kidney Disease ◽

Resistant Hypertension ◽

Chronic Kidney Disease Stage ◽

Growth Restriction ◽

Primary Hyperaldosteronism ◽

Disease Stage ◽

Uncontrolled Hypertension ◽

Progression Of Kidney Disease ◽

History Of ◽

In Pregnancy

Case Presentation: A 42-year-old woman with history of primary hyperaldosteronism (PA), IDDM and chronic kidney disease stage 3b (baseline Cr 2.5 mg/dl) presented at 10 weeks gestation with uncontrolled hypertension during pregnancy. Given prior difficulties conceiving and lack of discussions surrounding pregnancy risks, preconception counseling had not been done. She was taking carvedilol, spironolactone, and furosemide at pregnancy diagnosis. Given unclear safety profile in pregnancy, her spironolactone was discontinued. Her regimen was uptitrated to nifedipine 90 mmHg, carvedilol 50mg BID, hydralazine 50mg TID and furosemide 80mg BID. At 18 weeks gestation, she was readmitted with severe range hypertension and fluid overload unresponsive to escalating diuretic dosing. Due to poor urine output and creatinine to 5.5 mg/dl, she was initiated on dialysis. Her fetus was diagnosed with severe intrauterine growth restriction (IUGR) and umbilical doppler noted reversal of umbilical artery end-diastolic flow indicating severely elevated arterial resistance (Figure). During admission, she developed resistant hypertension requiring nicardipine and esmolol drips and severe headache, concerning for superimposed preeclampsia (SIPE). At 25 weeks gestation, she was taken for urgent c-section. Given extreme prematurity and growth restriction, her newborn baby passed away shortly after delivery. Discussion: This case highlights complications which arise from PA and antepartum persistent hypertension including progression of kidney disease, heart failure, IUGR, SIPE, and preterm delivery. It further highlights unique challenges using targeted therapies of mineralocorticoid receptor antagonists in PA in pregnancy. This information is crucial as PA is an increasingly recognized cause of resistant hypertension in young adults. Both PA and preeclampsia involve pathophysiologic mechanisms in the RAAS pathway and deserve further attention and research.

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Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study

The Lancet ◽

10.1016/s0140-6736(08)60834-x ◽

2008 ◽

Vol 371 (9628) ◽

pp. 1921-1926 ◽

Cited By ~ 281

Author(s):

Stella Douma ◽

Konstantinos Petidis ◽

Michael Doumas ◽

Panagiota Papaefthimiou ◽

Areti Triantafyllou ◽

...

Keyword(s):

Observational Study ◽

Resistant Hypertension ◽

Primary Hyperaldosteronism ◽

Retrospective Observational Study

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Eplerenone as a treatment for resistant hypertension in pregnancy

Obstetric Medicine ◽

10.1177/1753495x19825967 ◽

2019 ◽

pp. 1753495X1982596

Author(s):

Jessica Gehlert ◽

Adam Morton

Keyword(s):

Obstructive Sleep Apnoea ◽

Resistant Hypertension ◽

Mineralocorticoid Receptor ◽

Sleep Apnoea ◽

Primary Hyperaldosteronism ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists ◽

Mineralocorticoid Receptor Antagonist ◽

Obstructive Sleep ◽

In Pregnancy

Mineralocorticoid receptor antagonists are highly effective in the management of resistant hypertension and primary hyperaldosteronism. Recent studies demonstrate that mineralocorticoid receptor antagonists significantly reduce blood pressure, severity of obstructive sleep apnoea and arterial stiffness in patients with resistant hypertension and moderate–severe obstructive sleep apnoea. Eplerenone is a selective mineralocorticoid receptor antagonist that does not act as an androgen receptor blocker, thus reducing the risk of fetal anti-androgenic effects. Rat and rabbit studies demonstrated that when exposed to 30 times the equivalent therapeutic human dose, 100 mg/day, there were no teratogenic or demasculinisation effects. To date, the use of eplerenone has been reported in six human pregnancies in women with Gitelman syndrome, primary hyperaldosteronism and cardiac failure, in which no teratogenic effects were seen. Described here is a case of resistant hypertension associated with obstructive sleep apnoea in pregnancy, treated with eplerenone. The potential role of using eplerenone in pregnancy as treatment for resistant hypertension is discussed. Trial registration: Not applicable.

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OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS) AND OBESITY AS THE CAUSE OF PRIMARY HYPERALDOSTERONISM (PA) IN A POPULATION WITH RESISTANT HYPERTENSION

Journal of Hypertension ◽

10.1097/00004872-201106001-00627 ◽

2011 ◽

Vol 29 ◽

pp. e227

Author(s):

R. Muscherà ◽

M. Dʼavino ◽

G. Caruso ◽

A. Ilardi ◽

F. Capasso ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Syndrome ◽

Resistant Hypertension ◽

Sleep Apnea Syndrome ◽

Primary Hyperaldosteronism ◽

Obstructive Sleep ◽

Apnea Syndrome

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Hypertension and Recurrent Hypokalaemia in Young Woman - A Case Report of Primary Hyperaldosteronism (Conn’s Syndrome)

University Heart Journal ◽

10.3329/uhj.v12i2.36393 ◽

2018 ◽

Vol 12 (2) ◽

pp. 102-104

Author(s):

Md Nazmul Hasan ◽

Md Abdur Rahim ◽

Quazi Mamtaz Uddin Ahmed ◽

Md Syedul Islam ◽

Md Rasul Amin ◽

...

Keyword(s):

Case Report ◽

Young Woman ◽

Clinical Features ◽

Resistant Hypertension ◽

Plasma Aldosterone ◽

Primary Hyperaldosteronism ◽

Adrenal Hyperplasia ◽

Conn’S Syndrome ◽

Bilateral Adrenal Hyperplasia ◽

Aldosterone Producing Adenoma

Primary hyperaldosteronism is caused by most commonly due to aldosterone producing adenoma(conn’s syndrome) or bilateral adrenal hyperplasia. Clinical features may be of different type which includes hypertension in young age or resistant hypertension, recurrent hypokalaemia and characterized by increased ratio of plasma aldosterone (ng/dl) to rennin (ng/ml per hour) activity. We report a case of young woman presented with hypertension and recurrent hypokalaemia.University Heart Journal Vol. 12, No. 2, July 2016; 102-104

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Symptomatic arterial hypertension associated with primary hyperaldosteronism

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2017-23-3-224-230 ◽

2017 ◽

Vol 23 (3) ◽

pp. 224-230 ◽

Cited By ~ 2

Author(s):

A. N. Kalyagin ◽

V. A. Beloborodov ◽

T. M. Maksikova

Keyword(s):

Surgical Treatment ◽

Lactate Dehydrogenase ◽

Arterial Hypertension ◽

Resistant Hypertension ◽

Creatine Phosphokinase ◽

Primary Hyperaldosteronism ◽

Adrenal Tumors ◽

Therapeutic Practice ◽

Conn’S Syndrome ◽

Rare Phenomenon

Objective.Primary hyperaldosteronism (PGA) (Conn’s syndrome) is a relatively rare phenomenon in therapeutic practice, occurring in 4,7–9%. In resistant hypertension (HTN) the rate of PGA achieves 10–20%. Often it results from the aldosterone-producing adrenal tumors and manifests by symptomatic HTN, neuromuscular, and renal symptoms. We present the cases of successful verification and surgical treatment of PGA. HTN patients and patients with rhabdomyolysis symptoms (increased creatine phosphokinase or lactate dehydrogenase) require further examination to exclude PGA.

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