Background: PA is a frequent cause (513%) of secondary hypertension (HT), yet diagnostic work-up of PA remains challenging.
Aim: To describe the characteristics of hypertensive patients diagnosed with PA, biochemical screening (aldosterone:renin ratio/ARR), confirmatory tests, and adrenal CT results.
Methods: Clinical, hormonal and imaging evaluation.
Results: 13 patients (7M/6F) with PA were 45 yrs (4050) old at presentation (median/range). Ten patients (76.9%) had stage 3 and three had stage 2 HT. Systolic BP was 150 mmHg (140167.5), diastolic BP 100 mmHg (80110). Patients took 2 (24) classes of antihypertensives and HT duration was 10 yrs (015). Seven patients (53.8%) presented hypokaliemia history, while 2 associated sleep apneea. ARR on RAAS-interfering drugs (ARRon) was 72.6 (42.9164.9), serum potassium was 4.18 mmol/l (3.54.5); one patient associated unsuppressed cortisolemia=6.39 mc g/dl after 1 mg overnight dexamethasone. Repeated ARR after RAAS-interfering drugs discontinuation in 9 patients (ARRoff) was 82.35 (32.9626.7). We performed 15 confirmatory tests in 12 patients: 10 saline infusion tests (SIT), 4 captopril challenge tests (CCT) and one oral salt loading. Nine patients were SIT-positive (aldosterone> 5ng/dl), 2 patients were CCT-positive (aldosterone supression<30%), one CCT-negative patient (2h suppression=25.6%) was SIT-positive. SIT-positive patients had higher ARRon than CCT-positive patients (82.8 vs. 45.93). Adrenal CT identified unilateral adenomas in 8 patients (61.5%), 3 of whom associated a diffusely enlarged contralateral adrenal. One patient was biochemically cured after unilateral adrenalectomy, the remaining 12 received mineralocorticoid receptor antagonists. After 2.4 years (0.753.05) follow-up, 8 patients were controlled (BP<140/90 mmHg). Target organ complications were present in 10 (76.9%) patients: 8 presented cardiomiopathy, 8 had CKD and 3 patients had retinopathy.
Conclusions: PA was a frequent cause of severe secondary HT in our cohort. ARR was lower in patients taking RAAS-interfering medication. SIT-positivity associated with higher ARR than CCT-positivity. Unilateral adrenal nodules were more prevalent than idiopathic PA in our patients.