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Hypertension
Published in Clive Handler, Gerry Coghlan, Marie-Anne Essam, Preventing Cardiovascular Disease in Primary Care, 2018
Clive Handler, Gerry Coghlan, Marie-Anne Essam
These patients should be referred for confirmation and categorisation of the diagnosis and guidance on the most appropriate medical treatment, which is often necessary. Diagnosis is made by measuring 24-hour urinary aldosterone. The plasma aldosterone: plasma renin ratio after withdrawing antihypertensive treatment for two weeks is used, but interpretation of this test is difficult and controversial. Primary aldosteronism can be confirmed by the fludrocortisone suppression test (failure of four-day administration of the hormone to reduce plasma aldosterone and renin levels).
Primary aldosteronism
Published in Demetrius Pertsemlidis, William B. Inabnet III, Michel Gagner, Endocrine Surgery, 2017
Mihail Zilbermint, Constantine A. Stratakis
The plasma aldosterone-to-renin ratio (ARR) is a simple and reliable screening method of PA [4, 66–69]. The test was described in 1981 and has been validated in large series and at many centers. As aldosterone level rises, plasma renin activity (PRA) falls because of sodium retention. This negative feedback response occurs when aldosterone secretion is supraphysiologic [3].
Endocrine hypertension
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Frances McManus, John M. Connell, Marie Freel
Given his young age and lack of risk factors, he was screened for secondary causes of hypertension. The presence of hypokalemia increased clinical suspicion of PA, and an aldosterone-to-renin ratio (ARR) was measured. Plasma aldosterone was 650 pmol/L (100–400 pmol/L) and plasma renin (as plasma renin concentration [PRC]) was 1.2 mIU/L (0–40 mIU/L), giving an ARR of 542 (>35 suspicious).
Clinical presentation and diagnostic evaluation of pheochromocytoma: case series and literature review
Published in Clinical and Experimental Hypertension, 2023
Panagiota Anyfanti, Κonstantinos Mastrogiannis, Αntonios Lazaridis, Κonstantinos Tasios, Despoina Vasilakou, Αnastasia Kyriazidou, Fotios Aroutsidis, Olga Pavlidou, Εleni Papoutsopoulou, Athina Tiritidou, Vasileios Kotsis, Αreti Triantafyllou, Ιoannis Zarifis, Stella Douma, Εugenia Gkaliagkousi
2nd case: A 59-year-old male patient attended the emergency department due to increased blood pressure (BP) levels (220/120 mmHg) and tachycardia (120 bpm). He referred several episodes with similar symptoms over the past one and a half year, for which he had sought medical advice and was prescribed combined antihypertensive medication. The patient had already undergone an abdominal CT scan which revealed a 4.2 cm tumor at the anatomic location of the right adrenal gland, but it was characterized as an incidentaloma and he did not undergo further investigation. During his current visit at the emergency department, raised BP and tachycardia had already subsided at the time of the examination, and a reexamination was scheduled at the Outpatient Hypertension Department. Because of increased suspicion of secondary hypertension, the patient underwent biochemical screening for adrenal causes of hypertension. Screening for primary aldosteronism was negative (serum aldosterone: 16ng/dl; plasma renin activity: 1,2 ng/ml/h; aldosterone-to-renin ratio: 13,3). However, 24 h urine collection showed increased levels of both metanephrines (metanephrines 1,2 mg/24 h; normal values <0,37) and normetanephrines (6,7 mg/24 h; normal values <0,83), which, in combination with the abdominal imaging, led to the diagnosis of pheochromocytoma. To exclude the presence extra-adrenal neoplasm, 123Ι-ΜΙBG SPECT/CT was further performed, which confirmed the presence of unilateral pheochromocytoma in the right adrenal gland.
Adherence and blood pressure control in patients with primary aldosteronism
Published in Blood Pressure, 2022
Thi Minh Phuong Nikrýnová Nguyen, Branislav Štrauch, Ondřej Petrák, Zuzana Krátká, Robert Holaj, Ivana Kurcová, Věra Marešová, Alena Pilková, Jan Hartinger, Petr Waldauf, Tomáš Zelinka, Jiří Widimský
All subjects underwent prior thorough investigation for potential secondary hypertension during hospitalisation in our clinic due to severity of hypertension and/or hypokalaemia. The screening/diagnosis of PA was based on repeatedly elevated serum aldosterone concentrations (above 20 ng/dl), low direct plasma renin (below 3 pg/ml) and repeatedly high aldosterone-to-renin ratio (ARR) above 5.7 (ARR expressed in ng/dl per pg/ml) [16]. The diagnosis of PA was confirmed in all patients by the confirmatory test with saline infusion in agreement with the current guidelines/position paper [16,17]. The cut-off value of 7 ng/dl for plasma aldosterone after 4 h of 2 l saline infusion was used. PA patients were treated by conservative approach because of bilateral aldosterone overproduction based on adrenal venous sampling or due to refusal of surgery.
Preclinical cardiac disease in women and men with primary aldosteronism
Published in Blood Pressure, 2021
Arleen Aune, Marina Kokorina, Marianne Aa. Grytaas, Helga Midtbø, Kristian Løvås, Eva Gerdts
We recruited consecutively 109 patients diagnosed with PA at Haukeland University hospital between 2013 and 2016. In patients with elevated aldosterone-to-renin ratio, PA was confirmed by recumbent saline infusion testing, with a positive test defined as post-infusion plasma aldosterone level > 140 pmol/L [16]. Adrenal vein sampling, under continuous cosyntropin infusion, was performed for subtype differentiation at time of study inclusion. Unilateral disease was found in 47%, with no difference between sexes. Interfering medication was withdrawn for 2–4 weeks before diagnostic assessments. Controls were identified among patients with EH that participated in the FAT-associated CardiOvasculaR dysfunction (FATCOR study), another study cohort established at the European Society of Hypertension Excellence Centre in Bergen [17]. EH and PA patients were matched for sex, presence of obesity and age within a five-year range. The study was conducted in accordance with the Declaration of Helsinki and approved by the Regional Ethics Committee. All participants signed written informed consent before inclusion.