The Unrecognized Prevalence of Primary Aldosteronism
Authors: Stefan Pilz, Martin R. Grübler, Verena Theiler-Schwetz, Oliver Malle, Christian Trummer
Journal: Annals of Internal Medicine (2020)

Letters20 October 2020The Unrecognized Prevalence of Primary AldosteronismStefan Pilz, MD, PhD, Martin R. Grübler, MD, Verena Theiler-Schwetz, MD, PhD, Oliver Malle, MD, and Christian Trummer, MD, PhDStefan Pilz, MD, PhDMedical University of Graz, Graz, Austria (S.P., M.R.G., V.T., O.M., C.T.)Search for more papers by this author, Martin R. Grübler, MDMedical University of Graz, Graz, Austria (S.P., M.R.G., V.T., O.M., C.T.)Search for more papers by this author, Verena Theiler-Schwetz, MD, PhDMedical University of Graz, Graz, Austria (S.P., M.R.G., V.T., O.M., C.T.)Search for more papers by this author, Oliver Malle, MDMedical University of Graz, Graz, Austria (S.P., M.R.G., V.T., O.M., C.T.)Search for more papers by this author, and Christian Trummer, MD, PhDMedical University of Graz, Graz, Austria (S.P., M.R.G., V.T., O.M., C.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1094 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Brown and colleagues' (1) cross-sectional study showed a high prevalence of primary aldosteronism that increases with the severity of arterial hypertension. Diagnostic criteria for primary aldosteronism were urinary aldosterone levels greater than 12 µg/24 h in participants with high sodium balance and suppressed renin activity. A major finding was that the currently recommended screening test for primary aldosteronism (that is, the aldosterone–renin ratio) had poor sensitivity between 22.2% and 50.0%. As such, diagnosing this condition on the basis of this value would have falsely classified most patients with primary aldosteronism as not having this disease (1, 2). ...References1. Brown JM, Siddiqui M, Calhoun DA, et al. The unrecognized prevalence of primary aldosteronism. A cross-sectional study. Ann Intern Med. 2020;173:10-20. [PMID: 32449886]. doi:10.7326/M20-0065 LinkGoogle Scholar2. Funder JW, Carey RM, Mantero F, 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 Scholar3. Funder JW. Primary aldosteronism: at the tipping point. Ann Intern Med. 2020;173:65-6. [PMID: 32449882]. doi:10.7326/M20-1758 LinkGoogle Scholar4. Pilz S, Keppel MH, Trummer C, et al. Diagnostic accuracy of the aldosterone-to-active renin ratio for detecting primary aldosteronism. J Endocr Soc. 2019;3:1748-58. [PMID: 31528833] doi:10.1210/js.2019-00145 CrossrefMedlineGoogle Scholar5. Pilz S, Kienreich K, Gaksch M, et al. Aldosterone to active renin ratio as screening test for primary aldosteronism: reproducibility and influence of orthostasis and salt loading. Horm Metab Res. 2014;46:427-32. [PMID: 24526370] doi:10.1055/s-0034-1367033 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Medical University of Graz, Graz, Austria (S.P., M.R.G., V.T., O.M., C.T.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1094. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Unrecognized Prevalence of Primary Aldosteronism Jenifer M. Brown , Mohammed Siddiqui , David A. Calhoun , Robert M. Carey , Paul N. Hopkins , Gordon H. Williams , and Anand Vaidya The Unrecognized Prevalence of Primary Aldosteronism Georgios P. Piaditis , Grigorios Kaltsas , Athina Markou , and George P. Chrousos The Unrecognized Prevalence of Primary Aldosteronism R. Haridian Sosa Barrios , Miriam Menacho-Román , A.L. Mataix , and Fernando Liaño García The Unrecognized Prevalence of Primary Aldosteronism Anand Vaidya , Jenifer M. Brown , Robert M. Carey , Mohammed Siddiqui , and Gordon H. Williams Metrics Cited byExpert opinion. Spironolactone: a new twist on an old story 20 October 2020Volume 173, Issue 8Page: 681-682KeywordsAldosteroneBlood plasmaConflicts of interestDisclosureHypertensionPathogenesisPatientsReproducibilityResearch laboratoriesSodium ePublished: 20 October 2020 Issue Published: 20 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...