Endocrine Abstracts

Primary aldosteronism (PA) or Conn’s syndrome is a condition in which one or both adrenal glands produce aldosterone in excess, independent of the normal renin-angiotensin-aldosterone system (RAAS) such that renin is typically suppressed and aldosterone is non-suppressible by sodium loading. This excessive and autonomous production of aldosterone causes hypertension, sodium retention, cardiovascular damage, increased potassium excretion that, if prolonged and severe, may lead to hypokalaemia. Under the Endocrine Society Clinical Practice Guideline, the trilogy of confirming the diagnosis of PA includes a suppressed renin level, aldosterone of greater than 550 pmol/L, and hypokalaemia. PA is the most common cause of endocrine hypertension but only less than one percent is screened for it, let alone diagnosed, globally. PA patients have a three-fold risk of cardiovascular morbidity and mortality than age-and-gender matched patients with essential hypertension. PA is surgically curable if caused by a unilateral adrenal adenoma and more novel, less-invasive and adrenal-sparing approaches such as endoscopy-guided radiofrequency ablation procedures are currently being performed in clinical trials. Bilateral PA is managed medically with mineralocorticoid antagonist therapy. About five percent of PA patients develop prolonged hypoaldosteronism post-unilateral adrenalectomy.

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