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The Journal of Clinical Endocrinology & Metabolism Vol. 89, No. 3 1045-1050
Copyright © 2004 by The Endocrine Society

EXTENSIVE PERSONAL EXPERIENCE

Increased Diagnosis of Primary Aldosteronism, Including Surgically Correctable Forms, in Centers from Five Continents

Paolo Mulatero, Michael Stowasser, Keh-Chuan Loh, Carlos E. Fardella, Richard D. Gordon, Lorena Mosso, Celso E. Gomez-Sanchez, Franco Veglio and William F. Young, Jr.

Hypertension Unit (P.M., F.V.), Department of Medicine and Experimental Oncology, University of Torino, 10133 Torino, Italy; Hypertension Unit (M.S., R.D.G.), Department of Medicine, University of Queensland, Princess Alexandra and Greenslopes Hospitals, Brisbane, Australia 4212; Endocrine Unit (K.-C. L.), Tan Tock Seng Hospital, Singapore, Republic of Singapore 308433; Department of Endocrinology (C.E.F., L.M.), Faculty of Medicine, P. Universidad Catòlica de Chile, 114D Santiago, Chile; Division of Endocrinology (C.E.G.-S.), University of Mississippi Medical Center, Jackson, Mississippi 39216; and Division of Endocrinology, Metabolism, Nutrition, and Internal Medicine (W.F.Y.), Mayo Clinic, Rochester, Minnesota 55905

Address all correspondence and requests for reprints to: Dr. Paolo Mulatero, Hypertension Unit, San Vito Hospital, Strada San Vito 34, 10133 Torino, Italy. E-mail: paolo.mulatero{at}libero.it.

Primary aldosteronism (PA) is a common form of endocrine hypertension previously believed to account for less than 1% of hypertensive patients. Hypokalemia was considered a prerequisite for pursuing diagnostic tests for PA. Recent studies applying the plasma aldosterone/plasma renin activity ratio (ARR) as a screening test have reported a higher prevalence. This study is a retrospective evaluation of the diagnosis of PA from clinical centers in five continents before and after the widespread use of the ARR as a screening test. The application of this strategy to a greater number of hypertensives led to a 5- to 15-fold increase in the identification of patients affected by PA. Only a small proportion of patients (between 9 and 37%) were hypokalemic. The annual detection rate of aldosterone-producing adenoma (APA) increased in all centers (by 1.3–6.3 times) after the wide application of ARR. Aldosterone-producing adenomas constituted a much higher proportion of patients with PA in the four centers that employed adrenal venous sampling (28–50%) than in the center that did not (9%). In conclusion, the wide use of the ARR as a screening test in hypertensive patients led to a marked increase in the detection rate of PA.

Abbreviations: APA, Aldosterone-producing adenoma; ARR, plasma aldosterone/PRA ratio; AVS, adrenal venous sampling; BAH, bilateral adrenal hyperplasia; CT, computed tomography; FH-II, familial hy-peraldosteronism type II; FST, fludrocortisone suppression test; GRA, glucocorticoid-remediable aldosteronism; PA, primary aldosteronism; PRA, plasma renin activity.




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