Primary aldosteronism during 20072011 in Iceland
G. Jónsdóttir1, J. Gudmundsson1, G. Birgisson1 & H. Sigurjónsdóttir1,2
Introduction: Recent publications regarding primary aldosteronism (PA) have challenged the concept of PA being a rare disease. In 2007 a standardized protocol for diagnosing and treating PA was introduced in Iceland for patients suspected of having PA. Data from the Icelandic Heart Association suggests that 3540% of the adult population (age 4667) have hypertension. The aim of this study was to gather information about PA as a cause of hypertension at the referral center for endocrine hypertension in Iceland.
Methods: A retrospective chart review was performed of all patients (age 18 and older) diagnosed with PA during 20072011 at the Landspitali University Hospital in Iceland, a referral center for the whole country (population of 318.000). All patients were diagnosed using the same standardized methods. Patients were taken off interfering medications 46 weeks prior. Screening was considered positive if patients had an increased morning -aldosterone and decreased renin levels and/or an increased 24 h urinary aldosterone secretion. Salt loading and positional tests were used to verify the diagnosis. All patients with verified PA were further examined with a CT scan and adrenal venous sampling (AVS). When AVS indicated unilateral disease, patients were offered a laparoscopic adrenalectomy. Patients with bilateral disease were given specified pharmacological treatment options.
Results: Thirty-three patients were diagnosed with PA, 16 patients had bilateral disease and 16 patients unilateral. The results from AVS in one patient is pending. All 16 patients with unilateral disease had an adrenalectomy, 11 of which had a cortical adenoma and four had adrenal hyperplasia. In one patient the PAD was inconclusive.
Conclusion: This study indicates that PA is an important cause of hypertension in Iceland, and emphasizes the importance of detecting curable causes of hypertension. Interestingly, unilateral hyperplasia was ¼ of unilateral PA.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.