Primary aldosteronism: a new insight into pathogenesis, diagnosis, and treatment in hypertensive patients

Primary aldosteronism (PA) is not only a leading cause of secondary and resistant hypertension, but is also quite frequent in unselected hypertensive patients. Moreover, PA is associated with increased cardiovascular risk, which is disproportionate to BP levels. In addition, timely diagnosis of PA and prompt initiation of treatment attenuate this increased risk. On the other hand, there are limited data regarding the usefulness of screening for PA in all asymptomatic or normokalemic hypertensive patients. More importantly, until now, no well-organized, large-scale, prospective, randomized controlled trial has proved the effectiveness of screening for PA for improving clinical outcome. Accordingly, until more relevant data are available, screening for PA should be considered in hypertensive patients with spontaneous or diuretic-induced hypokalemia as well as in those with resistant hypertension. However, screening for PA in all hypertensive patients cannot be currently recommended.

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Diagnosis and Treatment of Unilateral Forms of Primary Aldosteronism

Current Hypertension Reviews ◽

10.2174/15734021113099990008 ◽

2013 ◽

Vol 9 (2) ◽

pp. 156-165 ◽

Cited By ~ 8

Author(s):

Andrea Viola ◽

Davide Tizzani ◽

Silvia Monticone ◽

Valentina Crudo ◽

Maddalena Galmozzi ◽

...

Keyword(s):

Primary Aldosteronism ◽

Diagnosis And Treatment

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Evaluation of Biochemical Conditions Allowing Bypass of Confirmatory Testing in The Workup of Primary Aldosteronism: A Retrospective Study in a French Hypertensive Population

Hormone and Metabolic Research ◽

10.1055/a-0857-1620 ◽

2019 ◽

Vol 51 (03) ◽

pp. 172-177 ◽

Cited By ~ 3

Author(s):

Maud Vivien ◽

Emilie Deberles ◽

Remy Morello ◽

Aimi Haddouche ◽

David Guenet ◽

...

Keyword(s):

Primary Aldosteronism ◽

Dynamic Testing ◽

Challenge Test ◽

Plasma Aldosterone ◽

Aldosterone Secretion ◽

Plasma Aldosterone Concentration ◽

Hypertensive Patients ◽

Hypertensive Population ◽

Tertiary Center ◽

Aldosterone To Renin Ratio

AbstractThe diagnostic workup for primary aldosteronism includes a screening step using the aldosterone-to-renin ratio (ARR) and a confirmatory step based on dynamic testing of aldosterone secretion autonomy. International guidelines suggest that precise clinical and biochemical conditions may allow the bypassing of the confirmatory step, however, data which validate hormone thresholds defining such conditions are lacking. At our tertiary center, we retrospectively examined a cohort of 173 hypertensive patients screened for PA by the ARR, of whom 120 had positive screening and passed a saline infusion test (SIT) or a captopril challenge test (CCT). Fifty-nine had PA, including 34 Conn adenomas and 25 with idiopathic aldosteronism (IA). Using a threshold of 160 pmol/l, post-SIT plasma aldosterone concentration (PAC) identified PA with 86.4% sensitivity, 94.7% specificity, and a negative predictive value of 92.3%. Of those subjects with a high ARR and a PAC above 550 pmol/l, 93% had a positive SIT, while 100% of subjects with a high ARR, but a PAC under 240 pmol/l had a negative SIT. Our results thus validate the biochemical conditions defined in the French and US guidelines for bypassing the confirmatory step in the workup for PA diagnosis.

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Free and Conjugated Catecholamines in Human Hypertension

Clinical Science ◽

10.1042/cs055077s ◽

1978 ◽

Vol 55 (s4) ◽

pp. 77s-80s ◽

Cited By ~ 1

Author(s):

O. Kuchel ◽

N. T. Buu ◽

TH. Unger ◽

J. Genest

Keyword(s):

Mean Arterial Pressure ◽

Arterial Pressure ◽

Primary Aldosteronism ◽

Adrenal Vein ◽

Elevated Plasma ◽

Hypertensive Patients ◽

Human Hypertension ◽

Control Subjects ◽

Urinary Dopamine ◽

Noradrenaline And Adrenaline

1. Noradrenaline and adrenaline in the adrenal vein of essential hypertensive patients are almost exclusively (99%) unconjugated or free. However only 17% of dopamine is free, the rest is conjugated. The further the site of sampling from the adrenal vein the closer come the free catecholamines to their normal peripheral venous proportion (noradrenaline + adrenaline 20%, dopamine less than 1% of total catecholamines). Deviations from these patterns help to detect the site and type of secretion of phaeochromocytoma. 2. Essential hypertensive patients have, compared with control subjects, higher conjugated plasma dopamine, less urinary free and conjugated dopamine with blunted urinary free dopamine and sodium responsiveness to frusemide. Conjugated noradrenaline + adrenaline, mean arterial pressure and age are positively interrelated. 3. Patients with primary aldosteronism have elevated plasma and urinary total dopamine. After removal of the adenoma urinary dopamine excretion decreases to normal. 4. Elevated conjugated dopamine appears to reflect a compensatory activation of the dopaminergic vasodilator pathway in hypertension, the total urinary dopamine excretion an intrinsic deficiency or compensatory increase of a dopamine-modulated natriuretic mechanism.

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Diagnosis and treatment of primary aldosteronism

Reviews in Endocrine and Metabolic Disorders ◽

10.1007/s11154-011-9162-8 ◽

2011 ◽

Vol 12 (1) ◽

pp. 27-36 ◽

Cited By ~ 20

Author(s):

Gian Paolo D. Rossi

Keyword(s):

Primary Aldosteronism ◽

Diagnosis And Treatment

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An Insight into the Polymeric Nanoparticles Applications in Diabetes Diagnosis and Treatment

Mini-Reviews in Medicinal Chemistry ◽

10.2174/1389557521666211116123002 ◽

2021 ◽

Vol 21 ◽

Author(s):

Parisa Dehghani ◽

Monireh Esameili Rad ◽

Atefeh Zarepour ◽

Ponnurengam Malliappan Sivakumar ◽

Ali Zarrabi

Keyword(s):

Polymeric Nanoparticles ◽

Synthetic Polymers ◽

Diagnostic Methods ◽

Diagnosis And Treatment ◽

Diabetes Diagnosis ◽

Transport Mechanisms ◽

Different Types ◽

Treatment And Diagnosis ◽

Insight Into

: Diabetes mellitus (DM) is a type of chronic metabolic disease that has affected millions of people worldwide and is known with a defect in the amount of insulin secretion, insulin functions, or both. This deficiency leads to an increase in the amounts of glucose, which could be accompanied by long-term damages to other organs such as eyes, kidneys, heart, and nervous system. Thus, introducing an appropriate approach for diagnosis and treatment of different types of DM is the aim of several researches. By the emergence of nanotechnology and its application in medicine, new approaches were presented for these purposes. The object of this review article is to introduce different types of polymeric nanoparticles (PNPs), as one of the most important classes of nanoparticles, for diabetic management. To achieve this goal, at first, some of the conventional therapeutic and diagnostic methods of DM will be reviewed. Then, different types of PNPs, in two forms of natural and synthetic polymers with different properties, as a new method for DM treatment and diagnosis will be introduced. In the next section, the transport mechanisms of these types of nano-carriers across the epithelium, via paracellular and transcellular pathways will be explained. Finally, the clinical use of PNPs in the treatment and diagnosis of DM will be summarized. Based on the results of this literature review, PNPs could be considered one of the most promising methods for DM management.

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