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Hundemer GL, Leung AA, Kline GA, Brown JM, Turcu AF, Vaidya A. Biomarkers to Guide Medical Therapy in Primary Aldosteronism. Endocr Rev 2024; 45:69-94. [PMID: 37439256 PMCID: PMC10765164 DOI: 10.1210/endrev/bnad024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/23/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023]
Abstract
Primary aldosteronism (PA) is an endocrinopathy characterized by dysregulated aldosterone production that occurs despite suppression of renin and angiotensin II, and that is non-suppressible by volume and sodium loading. The effectiveness of surgical adrenalectomy for patients with lateralizing PA is characterized by the attenuation of excess aldosterone production leading to blood pressure reduction, correction of hypokalemia, and increases in renin-biomarkers that collectively indicate a reversal of PA pathophysiology and restoration of normal physiology. Even though the vast majority of patients with PA will ultimately be treated medically rather than surgically, there is a lack of guidance on how to optimize medical therapy and on key metrics of success. Herein, we review the evidence justifying approaches to medical management of PA and biomarkers that reflect endocrine principles of restoring normal physiology. We review the current arsenal of medical therapies, including dietary sodium restriction, steroidal and nonsteroidal mineralocorticoid receptor antagonists, epithelial sodium channel inhibitors, and aldosterone synthase inhibitors. It is crucial that clinicians recognize that multimodal medical treatment for PA can be highly effective at reducing the risk for adverse cardiovascular and kidney outcomes when titrated with intention. The key biomarkers reflective of optimized medical therapy are unsurprisingly similar to the physiologic expectations following surgical adrenalectomy: control of blood pressure with the fewest number of antihypertensive agents, normalization of serum potassium without supplementation, and a rise in renin. Pragmatic approaches to achieve these objectives while mitigating adverse effects are reviewed.
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Affiliation(s)
- Gregory L Hundemer
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
| | - Alexander A Leung
- Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Gregory A Kline
- Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jenifer M Brown
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Adina F Turcu
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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2
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Kotanidou EP, Giza S, Tsinopoulou VR, Vogiatzi M, Galli-Tsinopoulou A. Diagnosis and Management of Endocrine Hypertension in Children and Adolescents. Curr Pharm Des 2020; 26:5591-5608. [PMID: 33185153 DOI: 10.2174/1381612826666201113103614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Hypertension in childhood and adolescence has increased in prevalence. Interest in the disease was raised after the 2017 clinical practice guidelines of the American Academy of Paediatrics on the definition and classification of paediatric hypertension. Among the secondary causes of paediatric hypertension, endocrine causes are relatively rare but important due to their unique treatment options. Excess of catecholamine, glucocorticoids and mineralocorticoids, congenital adrenal hyperplasia, hyperaldosteronism, hyperthyroidism and other rare syndromes with specific genetic defects are endocrine disorders leading to paediatric and adolescent hypertension. Adipose tissue is currently considered the major endocrine gland. Obesity-related hypertension constitutes a distinct clinical entity leading to an endocrine disorder. The dramatic increase in the rates of obesity during childhood has resulted in a rise in obesity-related hypertension among children, leading to increased cardiovascular risk and associated increased morbidity and mortality. This review presents an overview of pathophysiology and diagnosis of hypertension resulting from hormonal excess, as well as obesity-related hypertension during childhood and adolescence, with a special focus on management.
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Affiliation(s)
- Eleni P Kotanidou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Styliani Giza
- Fourth Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Vasiliki-Regina Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Vogiatzi
- Division of Endocrinology and Diabetes, Children' s Hospital of Philadelphia, PA 19104, United States
| | - Assimina Galli-Tsinopoulou
- Second Department of Paediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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3
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 974] [Impact Index Per Article: 243.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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The neuropeptide substance P regulates aldosterone secretion in human adrenals. Nat Commun 2020; 11:2673. [PMID: 32471973 PMCID: PMC7260184 DOI: 10.1038/s41467-020-16470-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/06/2020] [Indexed: 02/08/2023] Open
Abstract
Aldosterone, produced by the adrenals and under the control of plasma angiotensin and potassium levels, regulates hydromineral homeostasis and blood pressure. Here we report that the neuropeptide substance P (SP) released by intraadrenal nerve fibres, stimulates aldosterone secretion via binding to neurokinin type 1 receptors (NK1R) expressed by aldosterone-producing adrenocortical cells. The action of SP is mediated by the extracellular signal-regulated kinase pathway and involves upregulation of steroidogenic enzymes. We also conducted a prospective proof-of-concept, double blind, placebo-controlled clinical trial aimed to investigate the impact of the NK1R antagonist aprepitant on aldosterone secretion in healthy male volunteers (EudraCT: 2008-003367-40, ClinicalTrial.gov: NCT00977223). Participants received during two 7-day treatment periods aprepitant (125 mg on the 1st day and 80 mg during the following days) or placebo in a random order at a 2-week interval. The primary endpoint was plasma aldosterone levels during posture test. Secondary endpoints included basal aldosterone alterations, plasma aldosterone variation during metoclopramide and hypoglycaemia tests, and basal and stimulated alterations of renin, cortisol and ACTH during the three different stimulatory tests. The safety of the treatment was assessed on the basis of serum transaminase measurements on days 4 and 7. All pre-specified endpoints were achieved. Aprepitant decreases aldosterone production by around 30% but does not influence the aldosterone response to upright posture. These results indicate that the autonomic nervous system exerts a direct stimulatory tone on mineralocorticoid synthesis through SP, and thus plays a role in the maintenance of hydromineral homeostasis. This regulatory mechanism may be involved in aldosterone excess syndromes. Adrenal aldosterone production is regulated by plasma angiotensin and potassium levels. Here the authors report that the neuropeptide substance P stimulates aldosterone production via neurokinin type 1 receptors (NK1R), and report a proof-of-concept placebo controlled clinical trial showing that a NK1R antagonist decreases aldosterone levels.
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Meng Z, Zhou L, Dai Z, Xu C, Qian G, Peng M, Zhu Y, Kwong JSW, Wang X. The Quality of Clinical Practice Guidelines and Consensuses on the Management of Primary Aldosteronism: A Critical Appraisal. Front Med (Lausanne) 2020; 7:136. [PMID: 32432118 PMCID: PMC7214671 DOI: 10.3389/fmed.2020.00136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/30/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Several guidelines and expert consensuses have been developed for management of primary aldosteronism (PA). It is important to understand the detailed recommendations and quality of these guidelines to help physicians make informed and reliable decision. Methods: PubMed, EMBASE, and three websites were searched for practice guidelines or consensuses of PA from inception to January 24, 2019. We summarized the major recommendations on the management of PA from these guidelines and consensuses. The Appraisal of Guidelines for Research and Evaluation II was used to assess quality of the included guidelines and consensuses. Results: We identified three clinical practice guidelines and three consensus statements. Most of the recommendations on the diagnosis and treatment of PA from these guidelines and consensuses were consistent. Some minor conflicts were recorded for patient's screen and confirmation test. All included guideline documents have a good quality (score, >70%) on the scope and purpose (mean score, 81.02%) and clarity of presentation of the recommendations (mean score, 86.88%). However, the reporting for the stakeholder involvement (mean score, 54.32%) and applicability (mean score, 47.92%) were insufficient. There was an insufficient rigorousness in most of the guideline documents (mean score, 45.56%) on the development process. The Endocrine Society practice guideline 2016 ranked highest in quality (score, 81.13%). Conclusions: Existing guideline documents provided valuable recommendations on the management of PA, but further efforts are needed to improve the methodological quality. The Endocrine Society practice guideline 2016 was recommended for use.
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Affiliation(s)
- Zhe Meng
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.,Department of Adrenal Hypertension, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Liang Zhou
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhe Dai
- Department of Adrenal Hypertension, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.,Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Chang Xu
- Chinese Evidence Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guofeng Qian
- Department of Urology, The First Hospital of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Mou Peng
- Department of Urology, The Second Hospital of Xiangya, Zhongnan University, Hangzhou, China
| | - Yuchun Zhu
- Department of Adrenal Hypertension, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Joey S W Kwong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
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Abstract
Primary aldosteronism (PA) is a common cause of secondary hypertension caused by excessive and inappropriate secretion of the hormone aldosterone from one or both adrenal glands. The prevalence of PA ranges from 10% in the general hypertensive population to 20% in resistant hypertension, yet only a small fraction of patients is diagnosed. Disease and symptom recognition, screening in indicated populations, multidisciplinary communication, and appropriate imaging and biochemical workup can identify patients who might benefit from effective and targeted treatment modalities. Effective treatments available include both surgical and medical approaches, usually dependent on the subtype of PA present. Our collective understanding of the pathophysiology of PA is expanded by recent developments in molecular biology and genetics, including understanding the specific somatic and germline mutations involved in pathogenesis. We review the pathophysiology, diagnostic workup, and treatment considerations for this disease process.
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Affiliation(s)
- Sean M Wrenn
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of General Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carrie C Lubitz
- Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Systematic review of the clinical outcomes of mineralocorticoid receptor antagonist treatment versus adrenalectomy in patients with primary aldosteronism. Hypertens Res 2019; 42:817-824. [PMID: 30948836 DOI: 10.1038/s41440-019-0244-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/16/2022]
Abstract
Primary aldosteronism (PA) is the most common cause of secondary hypertension. The aim of this study was to review the clinical outcomes after mineralocorticoid receptor (MR) antagonist treatment versus adrenalectomy treatment in patients with PA. Relevant medical literature from PubMed, the Cochrane Library, and the ICHUSHI database from 1985 to August 2017 was reviewed. Data extraction was performed independently by three authors. The incidence of cerebrovascular or cardiovascular disease, the improvement of left ventricular hypertrophy or hypokalemia, the severity of hypertension, the incidence of renal dysfunction, and the reduction in the number of oral antihypertensive agents were set as the clinical outcomes. Of the 302 articles selected, 16 were included in the final analysis. Regarding the two therapeutic strategies, no difference in the reduced incidence of cerebrovascular or cardiovascular disease, the prevalence of left ventricular hypertrophy or hypokalemia, or the severity of hypertension, as well as an increase in the incidence of renal dysfunction was observed. Regarding the decrease in the number of oral antihypertensive agents, more agents were reduced in patients who underwent adrenalectomy. Available evidence indicated that the clinical outcomes were not different in PA patients treated with MR antagonist or adrenalectomy, except for a reduction in the number of antihypertensive agents.
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Pons Fernández N, Moreno F, Morata J, Moriano A, León S, De Mingo C, Zuñiga Á, Calvo F. Familial hyperaldosteronism type III a novel case and review of literature. Rev Endocr Metab Disord 2019; 20:27-36. [PMID: 30569443 DOI: 10.1007/s11154-018-9481-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Less than 15% of hypertension cases in children are secondary to a primary hyperaldosteronism. This is idiopathic in 60% of the cases, secondary to a unilateral adenoma in 30% and 10% remaining by primary adrenal hyperplasia, familial hyperaldosteronism, ectopic aldosterone production or adrenocortical carcinoma.To date, four types of familial hyperaldosteronism (FH I to FH IV) have been reported. FH III is caused by germline mutations in KCNJ5, encoding the potassium channel Kir3.4. The mutations cause the channel to lose its selectivity for potassium, allowing large quantities of sodium to enter the cell. As a consequence, the membrane depolarizes, voltage-gated calcium channels open, calcium enters the cell, initiating the cascade that leads to aldosterone synthesis. Somatic mutations in KCNJ5 has also been described in aldosterone-producing adenomas. The most frequent presentation of FH III is with severe hyperaldosteronism symptoms and resistance to pharmacological therapy which leads to bilateral adrenalectomy. We will review current literature and describe a child with FH III due to a novel de novo deletion in KCNJ5 with wild phenotype as a sign of clinical variability of this disease.
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Affiliation(s)
- Natividad Pons Fernández
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain.
| | - Francisca Moreno
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Julia Morata
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Ana Moriano
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
| | - Sara León
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Carmen De Mingo
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Ángel Zuñiga
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Fernando Calvo
- Department of Pediatrics, Hospital Lluís Alcanyís de Xàtiva, Ctra. Xàtiva a Silla km 2, 46800, Xàtiva, Valencia, Spain
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Lefebvre H, Duparc C, Naccache A, Lopez AG, Castanet M, Louiset E. Paracrine Regulation of Aldosterone Secretion in Physiological and Pathophysiological Conditions. VITAMINS AND HORMONES 2018; 109:303-339. [PMID: 30678861 DOI: 10.1016/bs.vh.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Aldosterone secretion by the zona glomerulosa of the adrenal cortex is controlled by circulating factors including the renin angiotensin system (RAS) and potassium. Mineralocorticoid production is also regulated through an autocrine/paracrine mechanism by a wide variety of bioactive signals released in the vicinity of adrenocortical cells by chromaffin cells, nerve endings, cells of the immune system, endothelial cells and adipocytes. These regulatory factors include conventional neurotransmitters and neuropeptides. Their physiological role in the control of aldosterone secretion is not fully understood, but it is likely that they participate in the RAS-independent regulation of zona glomerulosa cells. Interestingly, recent observations indicate that autocrine/paracrine processes are involved in the pathophysiology of primary aldosteronism. The intraadrenal regulatory systems observed in aldosterone-producing adenomas (APA), although globally similar to those occurring in the normal adrenal gland, harbor alterations at different levels, which tend to strengthen the potency of paracrine signals to activate aldosterone secretion. Enhancement of paracrine stimulatory tone may participate to APA expansion and aldosterone hypersecretion together with somatic mutations of driver genes which activate the calcium signaling pathway and subsequently aldosterone synthase expression. Intraadrenal regulatory mechanisms represent thus promising pharmacological targets for the treatment of primary aldosteronism.
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Affiliation(s)
- Hervé Lefebvre
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, Rouen, France; Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, Rouen, France.
| | - Céline Duparc
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, Rouen, France
| | - Alexandre Naccache
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, Rouen, France; Unit of Pediatric Endocrinology, Department of Pediatrics, Rouen University Hospital, Rouen, France
| | - Antoine-Guy Lopez
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, Rouen, France; Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, Rouen, France
| | - Mireille Castanet
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, Rouen, France; Unit of Pediatric Endocrinology, Department of Pediatrics, Rouen University Hospital, Rouen, France
| | - Estelle Louiset
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Normandie University, UNIROUEN, INSERM, Rouen, France
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Update in diagnosis and management of primary aldosteronism. ACTA ACUST UNITED AC 2017; 56:360-372. [DOI: 10.1515/cclm-2017-0217] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/24/2017] [Indexed: 12/17/2022]
Abstract
Abstract
Primary aldosteronism (PA) is a group of disorders in which aldosterone is excessively produced. These disorders can lead to hypertension, hypokalemia, hypervolemia and metabolic alkalosis. The prevalence of PA ranges from 5% to 12% around the globe, and the most common causes are adrenal adenoma and adrenal hyperplasia. The importance of PA recognition arises from the fact that it can have a remarkably adverse cardiovascular and renal impact, which can even result in death. The aldosterone-to-renin ratio (ARR) is the election test for screening PA, and one of the confirmatory tests, such as oral sodium loading (OSL) or saline infusion test (SIT), is in general necessary to confirm the diagnosis. The distinction between adrenal hyperplasia (AH) or aldosterone-producing adenoma (APA) is essential to select the appropriate treatment. Therefore, in order to identify the subtype of PA, imaging exams such as computed tomography or magnetic ressonance imaging, and/or invasive investigation such as adrenal catheterization must be performed. According to the subtype of PA, optimal treatment – surgical for APA or pharmacological for AH, with drugs like spironolactone and amiloride – must be offered.
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Morimoto R, Ono Y, Tezuka Y, Kudo M, Yamamoto S, Arai T, Gomez-Sanchez CE, Sasano H, Ito S, Satoh F. Rapid Screening of Primary Aldosteronism by a Novel Chemiluminescent Immunoassay. Hypertension 2017; 70:334-341. [PMID: 28652474 DOI: 10.1161/hypertensionaha.117.09078] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/01/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
Measurement of plasma aldosterone and renin concentration, or activity, is useful for selecting antihypertensive agents and detecting hyperaldosteronism in hypertensive patients. However, it takes several days to get results when measured by radioimmunoassay and development of more rapid assays has been long expected. We have developed chemiluminescent enzyme immunoassays enabling the simultaneous measurement of both aldosterone and renin concentrations in 10 minutes by a fully automated assay using antibody-immobilized magnetic particles with quick aggregation and dispersion. We performed clinical validation of diagnostic ability of this newly developed assay-based screening of 125 patients with primary aldosteronism from 97 patients with essential hypertension. Results of this novel assay significantly correlated with the results of radioimmunoassay (aldosterone, active renin concentration, and renin activity) and liquid chromatography-tandem mass spectrometry (aldosterone). The analytic sensitivity of this particularly novel active renin assay was 0.1 pg/mL, which was better than that of radioimmunoassay (2.0 pg/mL). The ratio of aldosterone-to-renin concentrations of 6.0 (ng/dL per pg/mL) provided 92.0% sensitivity and 76.3% specificity as a cutoff for differentiating primary aldosteronism from essential hypertension. This novel measurement is expected to be a clinically reliable alternative for conventional radioimmunoassay and to provide better throughput and cost effectiveness in diagnosis of hyperaldosteronism from larger numbers of hypertensive patients in clinical settings.
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Affiliation(s)
- Ryo Morimoto
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Yoshikiyo Ono
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Yuta Tezuka
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Masataka Kudo
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Sachiko Yamamoto
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Toshiaki Arai
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Celso E Gomez-Sanchez
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Hironobu Sasano
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Sadayoshi Ito
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.)
| | - Fumitoshi Satoh
- From the Division of Nephrology, Endocrinology and Vascular Medicine, Department of Medicine (R.M., Y.O., Y.T., M.K., S.I., F.S.) and Department of Pathology (H.S.), Tohoku University Hospital, Sendai, Miyagi, Japan; Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan (Y.T., F.S.); Diagnostics Research Laboratories, Diagnostics Development Operations, Diagnostics Division, Wako Pure Chemical Industries, Ltd, Osaka, Japan (S.Y., T.A.); and Division of Endocrinology, G.V. (Sonny) Montgomery VA Medical Center and University of Mississippi Medical Center, Jackson (C.E.G.-S.).
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