Pathogenetic forms of primary hyperaldosteronism: the analysis of clinical series of patients

Abstract

Frequency of different clinical variants of primary hyperaldosteronism (PHA) has a particular interest for modern endocrinology because paradigm in understanding the pathogenesis of disease were changed.Purpose. The aim of the study was to establish the frequency of different clinical variants of PHA on the cohort of patients treated in Ukrainian Scientific and Practical Center of Endocrine Surgery within period of 1996–2014 years.Materials and methods. Results of diagnosis and treatment of 474 patients, who underwent surgical and therapeutic procedures, were retrospectively studied. All patients were investigated by screening of serum potassium, aldosteron-renin ratio, confirmation tests, multi-spiral computed tomography. Selective adrenal vein sampling was performed in 63 cases.Results and discussion. Analysis of PHA structure demonstrated the following distribution of forms: idiopathic adrenal hyperplasia – 235 (49.6%), aldosteron-producing adenoma – 195 (41.1%), primary (unilateral) adrenal hyperplasia – 36 (7.6%), familial forms of PHA – 6 (1.3%) (incl. GRA – 4, FH II – 2), adrenocortical carcinoma – 2 (0.4%). 255 patients were operated by unilateral laparoscopic adrenalectomy. Among 219 patients from the group of conservative treatment of PHA glucocorticoid-remediable aldosteronism (GRA) was suspected in у 22 patients and have been confirmed by ex-uvantibus treatment with dexamethasone in 4 patients. The rest of patients received treatment by antagonists of mineralocorticoid receptors.Conclusions. The first in Ukraine analysis of modern distribution clinical variants of PHA has demonstrated variability of disease with predomination of idiopathic bilateral adrenal hyperplasia and gradually decreasing the share of aldosteron- producing adenoma. Accurate diagnosis of specific form of primary hyperaldosteronism allows choosing adequate mode of therapy.