Endocrine Abstracts (2011) 26 MTE2

Primary hyperaldosteronism

M Stowasser

Endocrine Hypertension Research Centre, Greenslopes and Princess Alexandra Hospitals, University of Queensland School of Medicine, Brisbane, Queensland, Australia.

It is now widely recognized that primary aldosteronism (PA) is much more common than previously thought, accounting for up to 5–10% of hypertensives with most patients normokalemic, and that aldosterone excess has adverse cardiovascular consequences that go above and beyond hypertension development. These findings have supported the concept that PA plays an important role in cardiovascular disease states and should be systematically sought and specifically treated. In recognition of this, the US Endocrine Society published in 2008 a clinical guideline for the case detection, diagnosis and management of this common, specifically treatable and potentially curable condition. Areas of recent, topical research include i) the demonstration of excess morbidity (including cardiovascular and renal) in patients with PA compared with other forms of hypertension and reduced quality of life, confirming the clinical relevance of non-blood pressure-dependent adverse effects of aldosterone excess; ii) the further demonstration that this excess morbidity is ameliorated with specific (but not non-specific antihypertensive) therapy directed against aldosterone excess, confirming the importance of detection and diagnosis of PA to enable optimal specific management; iii) an ongoing appraisal and refinement of diagnostic approaches including the recent demonstration that treatment with beta-blockers, female gender and the luteal phase of the menstrual cycle are associated with higher aldosterone/renin ratios and hence a greater risk of false positive results whereas selective serotonin reuptake inhibitors can lower the ratio and thus may increase the risk of false negatives; iv) the importance of assay reliability and the development of new, rapid-throughput, highly reliable and reproducible mass spectrometric methods of measuring aldosterone; and v) further insights into the importance and nature of causative genetic factors, the identification of which is being sought through high-throughput next generation sequencing technologies.

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