Endocrine Abstracts (2007) 14 P457

Retrospective analysis of diagnostic and treatment outcomes of primary aldosteronism

Nikolette Szücs1, Edit Gláz1, Ibolya Varga1, Miklós Tóth1, Róbert Kiss1, Attila Patócs1, Ferenc Perner2, János Horányi3, Ferenc Molnár4, László Fütö4 & Károly Rácz1

1Semmelweis University, 2nd. Department of Medicine, Budapest, Hungary; 2Semmelweis University, Department of Transplantation and Surgery, Budapest, Hungary; 3Semmelweis University, 1st Department of Surgery, Budapest, Hungary; 4Markhot Ferenc Hospital, Ist Department of Medicine, Eger, Hungary.

The authors retrospectively analyzed the efficacy of diagnostic procedures and the outcome of treatment by the analysis of data of 187 patients with primary aldosteronism (PA) examined between 1958 and 2004 at the 2nd Department of Medicine of Semmelweis University. Aldosterone-producing adenoma (APA) was detected in 135 patients, whereas idiopathic hyperaldosteronism (IHA) was found in 46 patients. Other subtypes of PA included 5 patients with unilateral primary adrenocortical hyperplasia and one patient with adrenocortical carcinoma. Molecular biological studies of the aldosterone-synthase/11 β-hydroxylase gene chimera were carried out in 30 patients but none of them showed the presence of the chimeric gene. When comparing the clinical parameters of patients with APA and IHA, no significant differences were found in the time period between the diagnosis of hypertension and the diagnosis of PA, in blood pressure, or in serum potassium values. Normokalemic PA was found in 7 cases. The ratio of plasma aldosterone concentration (ng/dl) to plasma renin activity (ng/ml/h) was above 20 in all patients with APA and in all but 5 cases with IHA. The postural test combined with furosemide administration differentiated APA patients from those with IHA with a sensitivity of 69% and a specificity of 92%. In cases of adrenocortical adenomas not clearly detectable by radiological imaging techniques and in cases with bilateral adrenocortical adenomas, selective adrenal vein sampling was performed (n=55). All but 4 patients with APA underwent adrenalectomy. After surgery serum potassium concentration returned to normal in all patients showing low serum potassium levels before surgery. Also, the moderate to severe preoperative hypertension disappeared or improved after surgery. The relatively low frequency of normokalemic PA and a less frequent occurrence of IHA in this cohort of patients suggests that a significant number of PA cases that are not accompanied with severe hypokalemia may remain undetected in Hungary.

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