Primary Hyperaldosteronism: When to Suspect It and How to Confirm Its Diagnosis
Abstract
:1. Introduction
2. Cardiovascular Risk Associated with Primary Hyperaldosteronism (PA)
3. Clinical Manifestations
3.1. PA and Atrial Fibrillation
3.2. PA and Hyperparathyroidism
3.3. Hypoklemia
3.4. Hypertension
“Subclinical” PA
4. Diagnostic Approach
4.1. Screening for PA
Interpretation of Results
4.2. Confirmatory Tests
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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2009-JES-Guidelines [39] | 2016-ES-Guidelines [20] | 2020-ESH-Consensus [3] |
---|---|---|
All patients with hypertension |
|
|
Effect in Renin Secretion | Effect in Aldosterone Secretion | ARR | |
---|---|---|---|
Drugs | |||
ACEi | ↑↑ | ↓ | ↓ |
ARB | ↑↑ | ↓ | ↓ |
MRB | ↑↑↑ | ↑↑ | ↓ |
Diuretics | ↑↑↑ | ↑↑ | ↓ |
Amiloride | |||
Thiazide | |||
Loop diuretics | |||
Ca++-channel antagonist * | ↑ | N/↓ * | N/↓ |
NSAI | ↓ | ↓ | N/↑ |
β-blockers | ↓ | ↓ | N/↑ |
Clonidine | ↓ | ↓ | N/↑ |
Methyldopa | ↓ | ↓ | N/↑ |
Kalemia | |||
Hyperkalemia | N | ↑↑↑ | ↑ |
Hypokalemia | N | ↓↓↓ | ↓ |
Physiological | |||
Menstrual cycle | |||
Follicular phase | N | N | N |
Ovulation | ↑ | ↑ | N |
Luteal phase | ↑ | ↑↑ | ↑ |
Pregnancy | ↑↑↑ | ↑↑ | ↓ |
Orthostatism | ↑↑ | ↑↑ | ↓ |
Salt intake | |||
Low-salt diet | ↑↑↑ | ↑↑ | ↓ |
High-salt diet | ↓↓↓ | ↓↓ | ↓ |
Captopril Challenge Test (*) | Oral Salt Loading | Intravenous Saline Loading | |
---|---|---|---|
Methodology | Preparation: Correction of hypokalemia Modification of drugs interfering with the RAAS | ||
Salt intake during the 3 previous days should be at least 7.6 g/d when possible [80]. Keep in sitting position from at least 20–30 min before to the end of the test. Test should be performed before 9 a.m. | Salt intake should be increased for at least 3 days before urine collection to reach at least 11.7 g/d. | Increased salt intake is not necessary. Keeping a sitting position from at least 30 min before and during test. Test should be performed before 9 a.m. | |
Procedure: Oral administration of Captopril. Blood testing at basal and 60–90 min (with captopril 50 mg), or basal an 2 h (with captopril 25 mg) | Procedure: After 3 days of a high-salt diet, 24 h urine collection is performed. | Procedure: Infusion of 2 L of NaCl 0.9% through 4 h. Blood testing at basal and 4 h | |
Diagnostic criteria (*) | At the end of the test: PAC ≥ 12 ng/dL, or ARR ≥ 50 ng/dL/mL/h (≥5 in ng/dL * pg/mL), or decrement of PAC above 30% as compared to baseline. | Urinary aldosterone ≥12 µg/24 h with urinary Na ≥ 200 mmol/24 h. | At 4 h post infusion: PAC ≥ 6 ng/dL. |
Contraindication | Allergy to ACEi | Active heart failure Hypokalemia Uncontrolled hypertension Coronary disease | |
Precaution | Blood pressure could drop. | Hypokalemia could occur in next 48 h after salt loading is begun. Heart failure might be triggered. Blood pressure could increase during salt loading. | |
Hospitalization Required | No | No | Yes (ambulatory hospitalization) |
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Ruiz-Sánchez, J.G.; Pazos Guerra, M.; Meneses, D.; Runkle, I. Primary Hyperaldosteronism: When to Suspect It and How to Confirm Its Diagnosis. Endocrines 2022, 3, 29-42. https://doi.org/10.3390/endocrines3010003
Ruiz-Sánchez JG, Pazos Guerra M, Meneses D, Runkle I. Primary Hyperaldosteronism: When to Suspect It and How to Confirm Its Diagnosis. Endocrines. 2022; 3(1):29-42. https://doi.org/10.3390/endocrines3010003
Chicago/Turabian StyleRuiz-Sánchez, Jorge Gabriel, Mario Pazos Guerra, Diego Meneses, and Isabelle Runkle. 2022. "Primary Hyperaldosteronism: When to Suspect It and How to Confirm Its Diagnosis" Endocrines 3, no. 1: 29-42. https://doi.org/10.3390/endocrines3010003