Biochemical and clinical characteristics of patients with primary aldosteronism: Single centre experience.

Nataša Vujačić,Nevena Kalezić,Miloš Stojanović,Mirjana Stojković,Biljana Beleslin,Miloš Žarković,Aleksandar Diklić,Ivan Paunović,Nikola Slijepčević,Jasmina Ćirić,Vladan Živaljević

doi:10.2478/jomb-2019-0035

Nataša Vujačić, Nevena Kalezić + Show 9 more

Open Access

https://doi.org/10.2478/jomb-2019-0035

Copy DOI

Abstract

Primary aldosteronism (PA) is associated with increased prevalence of metabolic disorders (impaired glucose and lipid metabolism and insulin resistance), but also with more frequent cardiovascular, renal and central nervous system complications. Biochemical and clinical parameters were retrospectively analysed for 40 patients with PA caused by aldosterone-producing adenoma (APA) and compared to the control groups of 40 patients with nonfunctioning adrenal adenoma (NFA) and essential hypertension (HT), and 20 patients with adrenal Cushing syndrome (CS) or subclinical CS (SCS). Systolic, diastolic and mean arterial blood pressures were significantly higher in the PA group (p=0.004; p=0.002; p=0.001, respectively) than in NFA+HT group. PA patients had longer hypertension history (p=0.001) than patients with hypercorticism and all had hypokalaemia. This group showed the smallest mean tumour diameter (p<0.001). The metabolic syndrome was significantly less common in the PA group (37.5% vs. 70% in CS+SCS and 65% in NFA+HT group; p=0.015), although there was no significant difference in any of the analysed metabolic parameters between groups. PA group was found to have the most patients with glucose intolerance (81.8%), although the difference was not significant. The mean BMI for all three groups was in the overweight range. Patients with PA had higher microalbuminuria and a higher tendency for cardiovascular, renal and cerebrovascular events, but the difference was not significant. Our results support the importance of the early recognition of primary aldosteronism on the bases of clinical presentation, as well as an increased screening intensity.

Highlights

In the last fifteen years, increasing knowledge about numerous negative effects of inappropriately high serum aldosterone has led to a widespread interest in screening the general hypertensive population for primary aldosteronism (PA)
The aim of this study was to analyse the biochemical and clinical characteristics of PA patients referred to the largest Centre for Endocrine Surgery in Serbia, and to compare them with those found in groups suffering from hypercorticism due to adrenal adenoma and nonsecretory adrenal tumours with essential hypertension (EHT)
Our study included 40 patients with primary aldosteronism (PA group) and two control groups, the first comprising 40 patients with nonfunctional adrenal adenoma (NFA) and essential hypertension (HT), and the second group consisting of 20 patients with hypercorticism due to adrenocortical tumour, 10 with Cushing’s syndrome (CS) and 10 with subclinical Cushing syndrome (CS) (SCS)

Summary

Introduction

In the last fifteen years, increasing knowledge about numerous negative effects of inappropriately high serum aldosterone has led to a widespread interest in screening the general hypertensive population for primary aldosteronism (PA). A trend of diagnosing milder forms of PA due to IAH has been observed, as is confirmed in the largest and most recent study [4]. Clinical picture of aldosterone-producing adenoma (APA) is more specific due to the signs of the frequently present hypokalaemia [5]. Still, it accounts for one third of all PA cases, meaning that surgically correctable aldosteronism is not so frequent among general hypertensive population

Objectives

Methods

Results

Discussion

Conclusion