Primary Aldosteronism: At the Tipping Point
Authors: John W. Funder
Journal: Annals of Internal Medicine (2020)

Editorials7 July 2020Primary Aldosteronism: At the Tipping PointJohn W. Funder, MD, PhDJohn W. Funder, MD, PhDHudson Institute of Medical Research, Wandin East, Victoria, Australia (J.W.F.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-1758 Annals Author Insight Video - John W. Funder, MD, PhD In this video, John W. Funder, MD, PhD, offers additional insight into the article, "Primary Aldosteronism: At the Tipping Point." (Duration 3:58) SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In their article, Brown and colleagues (1) report a study of the prevalence of unrecognized primary aldosteronism that is a game changer. The study shows that the single spot measurement of plasma aldosterone concentration, which clinicians have used for decades to screen for primary aldosteronism, is not merely useless but actually misleading. The authors caution readers about the uncertain representativeness of the study population for the U.S. population, but I believe that the findings are generalizable to the United States and elsewhere.Yet no study is perfect. Study participants from Boston, Massachusetts; Charlottesville, Virginia; and Salt Lake City, Utah, included ...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. doi:10.7326/M20-0065 LinkGoogle Scholar2. Markou A, Sertedaki A, Kaltsas G, et al. Stress-induced aldosterone hyper-secretion in a substantial subset of patients with essential hypertension. J Clin Endocrinol Metab. 2015;100:2857-64. [PMID: 25974737] doi:10.1210/jc.2015-1268 CrossrefMedlineGoogle Scholar3. Baudrand R, Guarda FJ, Fardella C, et al. Continuum of renin-independent aldosteronism in normotension. Hypertension. 2017;69:950-956. [PMID: 28289182] doi:10.1161/HYPERTENSIONAHA.116.08952 CrossrefMedlineGoogle Scholar4. Helber A, Wambach G, Hummerich W, et al. Evidence for a subgroup of essential hypertensives with non-suppressible excretion of aldosterone during sodium loading. Klin Wochenschr. 1980;58:439-47. [PMID: 6993778] CrossrefMedlineGoogle Scholar5. Gouli A, Kaltsas G, Tzonou A, et al. High prevalence of autonomous aldosterone secretion among patients with essential hypertension. Eur J Clin Invest. 2011;41:1227-36. [PMID: 21534948] doi:10.1111/j.1365-2362.2011.02531.x CrossrefMedlineGoogle Scholar6. Williams B, Brown MJ. Investigation of primary aldosteronism in patients with resistant hypertension - authors' reply [Letter]. Lancet Diabetes Endocrinol. 2018;6:600-1. [PMID: 30053984] doi:10.1016/S2213-8587(18)30174-8 CrossrefMedlineGoogle Scholar7. Hundemer GL, Curhan GC, Yozamp N, et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6:51-59. [PMID: 29129576] doi:10.1016/S2213-8587(17)30367-4 CrossrefMedlineGoogle Scholar8. 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 Scholar Author, Article, and Disclosure InformationAffiliations: Hudson Institute of Medical Research, Wandin East, Victoria, Australia (J.W.F.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-1758.Corresponding Author: John W. Funder, MD, PhD, Hudson Institute of Medical Research, 64 Parker Road, Wandin East, Victoria 3139, Australia; e-mail, john.[email protected]org.au.This article was published at Annals.org on 26 May 2020. PreviousarticleNextarticle Advertisement Annals Author Insight Video - John W. Funder, MD, PhD In this video, John W. Funder, MD, PhD, offers additional insight into the article, "Primary Aldosteronism: At the Tipping Point." (Duration 3:58) FiguresReferencesRelatedDetailsSee AlsoThe Unrecognized Prevalence of Primary Aldosteronism Jenifer M. Brown , Mohammed Siddiqui , David A. Calhoun , Robert M. Carey , Paul N. Hopkins , Gordon H. 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Grübler, MD, Verena Theiler-Schwetz, MD, PhD, Oliver Malle, MD, and Christian Trummer, MD, PhDPrimary AldosteronismPrimary aldosteronism: a consensus statement 7 July 2020Volume 173, Issue 1Page: 65-66KeywordsAdrenocorticotropic hormoneAldosteroneAttentionBlood plasmaBlood pressureCortisolExcretionHypertensionSodiumSystolic pressure ePublished: 26 May 2020 Issue Published: 7 July 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...