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Is there an epidemic of primary aldosteronism?

Journal of Human Hypertension volume 16, pages 151–152 (2002)Cite this article

There is a current debate in clinical hypertension that concerns the true frequency of primary aldosteronism (PA). The original description of an adrenal adenoma producing excess aldosterone, removal of which cured hypertension, was made by Conn in 1954. In its classical sporadic form, aldosteronism is high and renin suppressed. Aldosterone no longer responds to stimulation by angiotensin II, but follows a diurnal pattern entrained by ACTH. Plasma levels and urinary excretion of hybrid steroids such as 18-hydroxycortisol are higher than in normal subjects or patients with essential hypertension. Aldosterone secretion cannot be suppressed by manoeuvres that expand plasma volume, such as sodium loading (either with dietary supplements or intravenous saline or oral fludrocortisone).1 Histological examination of the adrenal adenoma shows distinctive features with cells showing a zona fasciculata-type morphology. There is often hyperplasia of adjacent zona glomerulosa. However, in a proportion of patients with aldosterone excess, no distinct adrenal adenoma is present; instead, there is nodular hyperplasia of both adrenal cortices. In these subjects, aldosterone is reported to respond to regulation by angiotensin II. For this reason the relationship between renin and aldosterone remains positive, albeit at a set point that is significantly different from that seen in normal subjects.2

Originally, the frequency of PA, of either type, was thought to be low, amounting to less than 2% of patients with hypertension. However, in the last few years, there have been numerous reports that have suggested that PA, diagnosed initially by a raised aldosterone-to-renin ratio is common and may be present in up to 10–15% of patients with hypertension.3,4 If this were true, there would be profound implications for our understanding of the nature of the heterogeneous entity labelled essential hypertension. In addition, investigative and therapeutic strategies would need to be revised.

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References

  1. Gordon RD et al. Primary aldosteronism and other forms of mineralocorticoid hypertension. In: Swales J (ed) Textbook of Hypertension Blackwell Scientific: Oxford 1994 pp 865–892

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  1. Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, G11 6NT, UK

    J M C Connell

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  1. J M C Connell
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Connell, J. Is there an epidemic of primary aldosteronism?. J Hum Hypertens 16, 151–152 (2002). https://doi.org/10.1038/sj.jhh.1001319

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  • DOI: https://doi.org/10.1038/sj.jhh.1001319

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