Subclinical Primary Aldosteronism
Authors: E. Victor Adlin
Journal: Annals of Internal Medicine (2017)

Editorials7 November 2017Subclinical Primary AldosteronismE. Victor Adlin, MDE. Victor Adlin, MDFrom Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2237 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The prevalence of primary aldosteronism (PA) in patients with hypertension has been widely disputed since the syndrome was first described by Jerome W. Conn in 1956. It was originally believed to be rare, but in 1964 Dr. Conn noted that 2 hallmarks of PA, low plasma renin activity (PRA) and adrenal adenomas, were present in many hypertensive persons. He suggested that the prevalence of PA, rather than less than 1%, might be as high as 20% (1).Within the next few years, low PRA levels were indeed noted in hypertensive patients (2). Increased mineralocorticoid activity was suspected in these patients ...References1. Conn JW. Plasma renin activity in primary aldosteronism. Importance in differential diagnosis and in research of essential hypertension. JAMA. 1964;190:222-5. [PMID: 14246593] CrossrefMedlineGoogle Scholar2. Channick BJ, Adlin EV, Marks AD. Suppressed plasma renin activity in hypertension. Arch Intern Med. 1969;123:131-40. [PMID: 4303266] CrossrefMedlineGoogle Scholar3. Adlin EV, Channick BJ, Marks AD. Salivary sodium-potassium ratio and plasma renin activity in hypertension. Circulation. 1969;39:685-92. [PMID: 5787319] CrossrefMedlineGoogle Scholar4. Woods JW, Liddle GW, Michelakis AM, Brill AB. Effect of an adrenal inhibitor in hypertensive patients with suppressed renin. Arch Intern Med. 1969;123:366-70. [PMID: 5778117] CrossrefMedlineGoogle Scholar5. Adlin EV, Marks AD, Channick BJ. Spironolactone and hydrochlorothiazide in essential hypertension. Blood pressure response and plasma renin activity. Arch Intern Med. 1972;130:855-8. [PMID: 5082465] CrossrefMedlineGoogle Scholar6. Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889-916. [PMID: 26934393] doi:10.1210/jc.2015-4061 CrossrefMedlineGoogle Scholar7. Markou A, Pappa T, Kaltsas G, Gouli A, Mitsakis K, Tsounas P, et al. Evidence of primary aldosteronism in a predominantly female cohort of normotensive individuals: a very high odds ratio for progression into arterial hypertension. J Clin Endocrinol Metab. 2013;98:1409-16. [PMID: 23471976] doi:10.1210/jc.2012-3353 CrossrefMedlineGoogle Scholar8. Brown MJ, Drake WM. Splitting atoms: the Endocrine Society guideline for the management of primary aldosteronism. Lancet Diabetes Endocrinol. 2016;4:805-7. [PMID: 27474215] doi:10.1016/S2213-8587(16)30154-1 CrossrefMedlineGoogle Scholar9. Brown JM, Robinson-Cohen C, Luque-Fernandez MA, Allison MA, Baudrand R, Ix JH, et al. The spectrum of subclinical primary aldosteronism and incident hypertension. A cohort study. Ann Intern Med. 2017;167:630-41. doi:10.7326/M17-0882 LinkGoogle Scholar10. Adlin EV, Braitman LE, Vasan RS. Bimodal aldosterone distribution in low-renin hypertension. Am J Hypertens. 2013;26:1076-85. [PMID: 23757402] doi:10.1093/ajh/hpt091 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.Disclosures: The author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2237.Corresponding Author: E. Victor Adlin, MD, Lewis Katz School of Medicine at Temple University, 3322 North Broad Street, Philadelphia, PA 19140; e-mail, [email protected]net.This article was published at Annals.org on 10 October 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Spectrum of Subclinical Primary Aldosteronism and Incident Hypertension Jenifer M. Brown , Cassianne Robinson-Cohen , Miguel Angel Luque-Fernandez , Matthew A. Allison , Rene Baudrand , Joachim H. Ix , Bryan Kestenbaum , Ian H. de Boer , and Anand Vaidya Annals On Call - Primary Aldosteronism: How Often Are We Missing It? Robert M. Centor and David A. Calhoun Metrics Cited byPrimary Aldosteronism: a Continuum from Normotension to HypertensionEvolution of the Primary Aldosteronism Syndrome: Updating the ApproachThe Expanding Spectrum of Primary Aldosteronism: Implications for Diagnosis, Pathogenesis, and TreatmentThe Low-Renin Hypertension Phenotype: Genetics and the Role of the Mineralocorticoid Receptor 7 November 2017Volume 167, Issue 9Page: 673-674KeywordsAdrenal adenomaAldosteroneBlood pressureHypertensionMineralocorticoidsPlasma renin activitySodiumSteroid hormonesThyroid diseasesThyroid-stimulating hormone ePublished: 10 October 2017 Issue Published: 7 November 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...