scholarly journals Primary Aldosteronism: A Glimpse into the Most Common Endocrine Cause of Arterial Hypertension

2019 ◽  
Author(s):  
Gian Paolo Rossi ◽  
Teresa M. Seccia
Keyword(s):  
Arterial Hypertension ◽  
Primary Aldosteronism

Clinical Score and Machine Learning-Based Model to Predict Diagnosis of Primary Aldosteronism in Arterial Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (5) ◽  
pp. 1595-1604
Author(s):  
Fabrizio Buffolo ◽  
Jacopo Burrello ◽  
Alessio Burrello ◽  
Daniel Heinrich ◽  
Christian Adolf ◽  
...  
Keyword(s):  
Machine Learning ◽  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Learning Algorithm ◽  
Area Under The Curve ◽  
Clinical Score ◽  
Machine Learning Algorithms ◽  
Supervised Machine Learning ◽  
Individual Risk ◽  
The Individual

Primary aldosteronism (PA) is the cause of arterial hypertension in 4% to 6% of patients, and 30% of patients with PA are affected by unilateral and surgically curable forms. Current guidelines recommend screening for PA ≈50% of patients with hypertension on the basis of individual factors, while some experts suggest screening all patients with hypertension. To define the risk of PA and tailor the diagnostic workup to the individual risk of each patient, we developed a conventional scoring system and supervised machine learning algorithms using a retrospective cohort of 4059 patients with hypertension. On the basis of 6 widely available parameters, we developed a numerical score and 308 machine learning-based models, selecting the one with the highest diagnostic performance. After validation, we obtained high predictive performance with our score (optimized sensitivity of 90.7% for PA and 92.3% for unilateral PA [UPA]). The machine learning-based model provided the highest performance, with an area under the curve of 0.834 for PA and 0.905 for diagnosis of UPA, with optimized sensitivity of 96.6% for PA, and 100.0% for UPA, at validation. The application of the predicting tools allowed the identification of a subgroup of patients with very low risk of PA (0.6% for both models) and null probability of having UPA. In conclusion, this score and the machine learning algorithm can accurately predict the individual pretest probability of PA in patients with hypertension and circumvent screening in up to 32.7% of patients using a machine learning-based model, without omitting patients with surgically curable UPA.

scholarly journals PRIMARY ALDOSTERONISM: THE RESULTS OF THE TREATMENT ACCORDING TO THE DATA OF RENAL ARTERIES DUPLEX SCANNING

World Science ◽  
2019 ◽  
Vol 2 (4(44)) ◽  
pp. 16-21
Author(s):  
Zubryk I. V.
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Renal Artery ◽  
Primary Aldosteronism ◽  
Reference Range ◽  
Renal Arteries ◽  
Duplex Scanning ◽  
Aldosterone Level ◽  
Before And After ◽  
Segmental Arteries

In the structure of arterial hypertension, primary aldosteronism (РА) ranges from 5 to 15%. Changes in intrarenal hemodynamics are due to both high blood pressure and direct aldosterone level. The purpose of the study was to analyze the results of PA treatment according to ultrasound doppler scanning of renal arteries. In general, 55 patients with PA were treated. Renal arteries duplex scanning before and after the treatment was performed in 20 patients. During treatment, the normalization of Vps, Ved, S/D, PI, PI, AT, TAMX indices was recorded in patients. The RI of the interlobar arteries slightly increased, however, it remained within the reference range. The reduction of aldosterone levels led to increase of TAMX index at the level of the renal artery trunk, S/D, RI and decrease in AT at the level of the segmental arteries, as well as increase of Ved and S/D at the level of the interlobar arteries.

Prevalence of Primary Aldosteronism Across the Stages of Hypertension Based on a New Combined Overnight Test

2021 ◽  
Vol 53 (07) ◽  
pp. 461-469
Author(s):  
Nick Voulgaris ◽  
Ernestini Tyfoxylou ◽  
Sophia Vlachou ◽  
Evagelia Kyriazi ◽  
Chris Gravvanis ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Adrenocorticotropic Hormone ◽  
Stage I ◽  
Aldosterone Secretion ◽  
Hypertensive Patients ◽  
True Prevalence ◽  
Normal Limits ◽  
Aldosterone To Renin Ratio ◽  
A Prospective Study

AbstractPrimary aldosteronism (PA) is the most common endocrine cause of arterial hypertension. Despite the increasing incidence of hypertension worldwide, the true prevalence of PA in hypertension was only recently recognized. The objective of the work was to estimate the prevalence of PA in patients at different stages of hypertension based on a newly developed screening-diagnostic overnight test. This is a prospective study with hypertensive patients (n=265) at stage I (n=100), II (n=88), and III (n=77) of hypertension. A group of 103 patients with essential hypertension without PA was used as controls. PA diagnosis was based on a combined screening-diagnostic overnight test, the Dexamethasone-Captopril-Valsartan Test (DCVT) that evaluates aldosterone secretion after pharmaceutical blockade of angiotensin-II and adrenocorticotropic hormone. DCVT was performed in all participants independently of the basal aldosterone to renin ratio (ARR). The calculated upper normal limits for post-DCVT aldosterone levels [3 ng/dl (85 pmol/l)] and post-DCVT ARR [0.32 ng/dl/μU/ml (9 pmol/IU)] from controls, were applied together to establish PA diagnosis. Using these criteria PA was confirmed in 80 of 265 (30%) hypertensives. The prevalence of PA was: 21% (21/100) in stage I, 33% (29/88) in stage II, and 39% (30/77) in stage III. Serum K+ levels were negatively correlated and urinary K+ was positively correlated in PA patients with post-DCVT ARR (r=–0.349, p <0.01, and r=0.27, p <0.05 respectively). In conclusion, DCVT revealed that PA is a highly prevalent cause of hypertension. DCVT could be employed as a diagnostic tool in all subjects with arterial hypertension of unknown cause.

scholarly journals Long-Term Control of Arterial Hypertension and Regression of Left Ventricular Hypertrophy With Treatment of Primary Aldosteronism

Hypertension ◽  
2013 ◽  
Vol 62 (1) ◽  
pp. 62-69 ◽  
Author(s):  
Gian Paolo Rossi ◽  
Maurizio Cesari ◽  
Cesare Cuspidi ◽  
Giuseppe Maiolino ◽  
Maria Verena Cicala ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Ventricular Hypertrophy ◽  
Left Ventricular

scholarly journals The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism

2020 ◽  
Vol 5 ◽  
pp. 100029 ◽  
Author(s):  
Gian Paolo Rossi ◽  
Valeria Bisogni ◽  
Alessandra Violet Bacca ◽  
Anna Belfiore ◽  
Maurizio Cesari ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Italian Society ◽  
Practical Guidelines

scholarly journals Molecular mechanisms in primary aldosteronism

2019 ◽  
Vol 242 (3) ◽  
pp. R67-R79 ◽  
Author(s):  
Kelly De Sousa ◽  
Alaa B Abdellatif ◽  
Rami M El Zein ◽  
Maria-Christina Zennaro
Keyword(s):  
Arterial Hypertension ◽  
Adrenal Cortex ◽  
Primary Aldosteronism ◽  
Molecular Mechanisms ◽  
Somatic Mutations ◽  
Type I ◽  
Adrenal Hyperplasia ◽  
New Genes ◽  
Aldosterone Production ◽  
Bilateral Adrenal Hyperplasia

Primary aldosteronism (PA) is the most common form and an under-diagnosed cause of secondary arterial hypertension, accounting for up to 10% of hypertensive cases and associated to increased cardiovascular risk. PA is caused by autonomous overproduction of aldosterone by the adrenal cortex. It is mainly caused by a unilateral aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia. Excess aldosterone leads to arterial hypertension with suppressed renin, frequently associated to hypokalemia. Mutations in genes coding for ion channels and ATPases have been identified in APA, explaining the pathophysiology of increased aldosterone production. Different inherited genetic abnormalities led to the distinction of four forms of familial hyperaldosteronism (type I to IV) and other genetic defects very likely remain to be identified. Somatic mutations are identified in APA, but also in aldosterone-producing cell clusters (APCCs) in normal adrenals, in image-negative unilateral hyperplasia, in transitional lesions and in APCC from adrenals with bilateral adrenal hyperplasia (BAH). Whether these structures are precursors of APA or whether somatic mutations occur in a proliferative adrenal cortex, is still a matter of debate. This review will summarize our knowledge on the molecular mechanisms responsible for PA and the recent discovery of new genes related to early-onset and familial forms of the disease. We will also address new issues concerning genomic and proteomic changes in adrenals with APA and discuss adrenal pathophysiology in relation to aldosterone-producing structures in the adrenal cortex.

scholarly journals Masked arterial hypertension in a 64-year-old man with primary aldosteronism

2021 ◽  
pp. 1-5
Author(s):  
Joanna Kanarek-Kucner ◽  
Beata Graff ◽  
Vlasta Bari ◽  
Rufus Barraclough ◽  
Krzysztof Narkiewicz ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Primary Aldosteronism

scholarly journals Primary aldosteronism and resistant arterial hypertension

2012 ◽  
Vol 18 (6) ◽  
pp. 514-521 ◽  
Author(s):  
N. E. Zvartau ◽  
L. S. Korostovtseva ◽  
I. V. Emelyanov ◽  
Yu. V. Sviryaev
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Antihypertensive Treatment ◽  
Organ Damage ◽  
Aldosterone Level ◽  
Pathophysiological Mechanisms ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

The review discusses the new data about primary aldosteronism and the connection between increase of aldosterone level and resistance to antihypertensive treatment, including patients with obstructive sleep apnea. Also the main pathophysiological mechanisms underlying the progression of end organ damage and leading to resistance to antihypertensive treatment in patients with high aldosterone level are presented.

The Challenge of Managing Hypertension in Patients with Diabetes or Other Endocrine Disorders

2010 ◽  
Vol 7 (1) ◽  
pp. 36
Author(s):  
Enrico Agabiti Rosei ◽  
Maurizio Castellano ◽  
◽  
Keyword(s):  
General Population ◽  
Arterial Hypertension ◽  
Primary Aldosteronism ◽  
Medical Advice ◽  
Endocrine Disorders ◽  
Endocrine Diseases ◽  
Relevant Condition ◽  
Major Complications ◽  
Patients With Diabetes ◽  
Diagnostic Work

Arterial hypertension is a frequent condition in the general population, but its prevalence increases in association with several endocrine diseases. Up to three-quarters of patients with diabetes are also hypertensive, and this association poses specific problems in the management of both conditions. Hypertension is a relevant condition in several other endocrinopathies and in some cases it is the main reason prompting patients to seek medical advice. Some of these endocrine diseases are frequent (primary aldosteronism) or may produce major complications (pheochromocytoma), and in any case require specific diagnostic work-ups and treatment.

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