Endocrine Abstracts

Introduction: Primary aldosteronism (PA) is commonly identified as the main cause of secondary hypertension. It is becoming increasingly wide-spread, affecting between 1 and 30% of people suffering from hypertension. We aim to describe the epidemiological, clinical and paraclinical characteristics of PA and to analyse its therapeutic and evolutionary aspects.

Patients and methods: Retrospective and descriptive study concerning 40 patients with PA, collected in the endocrinology department of the Hedi-Chaker University Hospital of Sfax, over the period of 10years from January 2010 to December 2022.

Findings: The average age of our patients was 55.4 years. They were composed of 16 men and 24 women. In 32% of cases, hypertension was recent, evolving for less than than 5 years. Severe hypertension was found in 11 cases and resistant hypertension in 4 others. Hypokalaemia was noted in 47.5% of cases, symptomatic of asthenia in the majority of cases (60%). The mean plasma aldosterone concentration was 250 pg/ml. The mean plasma renin concentration was 3.98 pg/ml, below 4.6 pg/ml in 28 cases. The aldosterone to renin ratio was greater than 23 in all cases, with a mean level of 41. The etiology of PA was dominated by bilateral adrenal hyperplasia (BAH) in 20 cases, aldosterone-producing adenoma in 17 cases and unilateral adrenal hyperplasia in 2 cases. One patient had a malignant adrenocortical carcinoma secreting aldosterone (ACC). Fourteen patients had cardiovascular involvement, characterized by electrical left ventricular hypertrophy and/or hypertrophic cardiomyopathy on echocardiography, and/or evidence of coronary insufficiency. Surgical treatment consisted of unilateral adrenalectomy in 8 cases. Twenty-eight patients were treated medically with spironolactone. The course of the disease was favourable with a reduction in the number of antihypertensive treatments. Follow-up of patients observed blood pressure control and normalization of potassium levels in all cases except the case of the malignant ACC, who died of a massive pulmonary embolism.

Conclusion: PA is an underdiagnosed cause of hypertension. Although it is traditionally associated with hypertension and low potassium levels, many patients with PA do not exhibit hypokalemia. The recommended treatment for those with unilateral disease is adrenalectomy. However, individuals who are unfit for surgery or have BAH can undergo medical treatment using mineralocorticoid antagonists alongside antihypertensive medications to better manage blood pressure. We highlight the need for early detection of PA and appropriate management of all hypertensive patients with cardiovascular comorbidities and/or metabolic syndrome, among others, in order to attenuate the harmful effects of excess aldosteronism.