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 hypertensionpreviously believed to account for less than 1% of hypertensivepatients. Hypokalemia was considered a prerequisite for pursuingdiagnostic tests for PA. Recent studies applying the plasmaaldosterone/plasma renin activity ratio (ARR) as a screeningtest have reported a higher prevalence. This study is a retrospectiveevaluation of the diagnosis of PA from clinical centers in fivecontinents before and after the widespread use of the ARR asa screening test. The application of this strategy to a greaternumber of hypertensives led to a 5- to 15-fold increase in theidentification of patients affected by PA. Only a small proportionof patients (between 9 and 37%) were hypokalemic. The annualdetection rate of aldosterone-producing adenoma (APA) increasedin all centers (by 1.3–6.3 times) after the wide applicationof ARR. Aldosterone-producing adenomas constituted a much higherproportion of patients with PA in the four centers that employedadrenal venous sampling (28–50%) than in the center thatdid not (9%). In conclusion, the wide use of the ARR as a screeningtest in hypertensive patients led to a marked increase in thedetection rate of PA.
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