Endocrinology and Metabolism

Special Article

Adrenal gland
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism: Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung, The Committee of Clinical Practice Guideline of Korean Endocrine Society, The Korean Adrenal Study Group of Korean Endocrine Society; Endocrinol Metab. 2023;38(6):597-618. Published online October 13, 2023; DOI: https://doi.org/10.3803/EnM.2023.1789

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Primary aldosteronism (PA) is a common, yet underdiagnosed cause of secondary hypertension. It is characterized by an overproduction of aldosterone, leading to hypertension and/or hypokalemia. Despite affecting between 5.9% and 34% of patients with hypertension, PA is frequently missed due to a lack of clinical awareness and systematic screening, which can result in significant cardiovascular complications. To address this, medical societies have developed clinical practice guidelines to improve the management of hypertension and PA. The Korean Endocrine Society, drawing on a wealth of research, has formulated new guidelines for PA. A task force has been established to prepare PA guidelines, which encompass epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, and follow-up care. The Korean clinical guidelines for PA aim to deliver an evidence-based protocol for PA diagnosis, treatment, and patient monitoring. These guidelines are anticipated to ease the burden of this potentially curable condition.

Citations

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Correlation of Histopathologic Subtypes of Primary Aldosteronism with Clinical Phenotypes and Postsurgical Outcomes
Chang Ho Ahn, You-Bin Lee, Jae Hyeon Kim, Young Lyun Oh, Jung Hee Kim, Kyeong Cheon Jung
The Journal of Clinical Endocrinology & Metabolism.2024; 109(8): e1582. CrossRef
Temporal trends in clinical features of patients with primary aldosteronism over 20 years
Seung Shin Park, Chang Ho Ahn, Sang Wan Kim, Jung-Min Koh, Seung Hun Lee, Jung Hee Kim
Hypertension Research.2024; 47(8): 2019. CrossRef
Primary aldosteronism: An underdiagnosed clinical entity
Peeyush Jain, Atul Kaushik, Nilashish Dey, Ashwani Mehta, Shaloo Kapoor, Chhavi Agrawal
Journal of Current Cardiology.2024; 2(2): 65. CrossRef
Historical changes in the clinical features of primary aldosteronism
Takamasa Ichijo
Hypertension Research.2024; 47(10): 2926. CrossRef
Comparing ARR Versus Suppressed PRA as Screening Tests for Primary Aldosteronism
Marco Marcelli, Caixia Bi, John W. Funder, Michael J. McPhaul
Hypertension.2024; 81(10): 2072. CrossRef
Screening and treatment of endocrine hypertension focusing on adrenal gland disorders: a narrative review
Seung Min Chung
Journal of Yeungnam Medical Science.2024; 41(4): 269. CrossRef
Differences in target organ damage between captopril challenge test-defined definitive-positive and borderline-range groups among patients with primary aldosteronism
Naoki Fujiwara, Tatsuya Haze, Hiromichi Wakui, Kouichi Tamura, Mika Tsuiki, Kohei Kamemura, Daisuke Taura, Takamasa Ichijo, Yutaka Takahashi, Minemori Watanabe, Hiroki Kobayashi, Toshifumi Nakamura, Shoichiro Izawa, Norio Wada, Tetsuya Yamada, Kenichi Yok
Hypertension Research.2024;[Epub] CrossRef
Diagnostic efficacy of aldosterone-to-renin ratio to screen primary aldosteronism in hypertension: a systemic review and meta-analysis
Ting-Wei Kao, Jui-Yi Chen, Jung-Hua Liu, Wen-Hsin Tseng, Chih-Chia Hsieh, Vin-Cent Wu, Yen-Hung Lin, Zheng-Wei Chen
Therapeutic Advances in Endocrinology and Metabolism.2024;[Epub] CrossRef
Comparative Analysis of Liquid Chromatography-Tandem Mass Spectrometry and Radioimmunoassay in Determining Plasma Aldosterone Concentration and Plasma Renin Activity for Primary Aldosteronism Screening
So Yoon Kwon, Kyeong-Jin Kim, Soo-Youn Lee, Jae Hyeon Kim
Endocrinology and Metabolism.2024; 39(6): 965. CrossRef

Case Report

A Case of Giant Adrenal Adenoma Presenting Primary Aldosteronism.: Ji Hyun Lee, Bong Soo Cha, Moon Suk Nam, Young Duk Song, Sung Kil Lim, Hyun Chul Lee, Kap Bum Huh, Hyung Chan Suh, Young Hwa Choi, Jae Min Park, Jung Soo Park, Soon Won Hong, Dong Hwan Shin; J Korean Endocr Soc. 1996;11(3):348-354. Published online November 7, 2019

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Abstract PDF: Primary aldosteronism is a syndrome chracterized by hypokalemic alkalosis and hypertension. Small sized adrenal cortical adenomas have been the major cause of this syndrome in most of the patients. However, if the adrenal mass is larger than 6cm in diameter and with irregular consistency, malignancy is more favored. We experienced a patient who had a giant adrenal adenoma with primary aldosteronism. A 24-year-old female presented with hypertension, hypokalemia, low plasma renin, and high plasrna aldosterone levels, was found to have a 6×5.5×5 cm sized left adrenal tumor by MRI. Her clinical laboratory feature did not revealed any evidence of Cushing's syndrome or pheochromocytoma. Preoperatively adrenal carcinoma presenting pure adrenal aldosteronism was suspected due to large size and heterogenous signal character of the adrenal mass in radiologic study. At operation well encapsulated, round giant adrenal tumor weighing 65gm(4.5×4×4 cm) was removed. There was no evidence of metastasis with return of adrenal function to normal after surgery. Benign adrenal adenoma was confirmed by the gross morphology and the histologic features.

Review Article

Adrenal gland
Primary Aldosteronism and Cerebrovascular Diseases: Zheng-Wei Chen, Chi-Sheng Hung, Vin-Cent Wu, Yen-Hung Lin; Endocrinol Metab. 2018;33(4):429-434. Published online November 30, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.4.429

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As diagnostic techniques have advanced, primary aldosteronism (PA) has emerged as the most common cause of secondary hypertension. The excess of aldosterone caused by PA resulted in not only cardiovascular complications, including coronary artery disease, myocardial infarction, arrhythmia, and heart failure, but also cerebrovascular complications, such as stroke and transient ischemic attack. Moreover, PA is associated more closely with these conditions than is essential hypertension. In this review, we present up-to-date findings on the association between PA and cerebrovascular diseases.

Citations

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Association of Dip in eGFR With Clinical Outcomes in Unilateral Primary Aldosteronism Patients After Adrenalectomy
Jui-Yi Chen, Kuo-How Huang, Yen-Hung Lin, Jeff S Chueh, Hsien-Yi Wang, Vin-Cent Wu
The Journal of Clinical Endocrinology & Metabolism.2024; 109(3): e965. CrossRef
Aldosterone and aldosterone synthase inhibitors in cardiorenal disease
Subodh Verma, Avinash Pandey, Arjun K. Pandey, Javed Butler, John S. Lee, Hwee Teoh, C. David Mazer, Mikhail N. Kosiborod, Francesco Cosentino, Stefan D. Anker, Kim A. Connelly, Deepak L. Bhatt
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Exploring the Spectrum of Comorbidities Associated with Primary Aldosteronism: Insights from a Large Real-World Case-Control Study
Andreas Krieg, Sarah Krieg, Andreas Heuser, Ulrich Laverenz, Valentin-Alin Istrate, Matthias Schott, Karel Kostev
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Cardiovascular and metabolic characters of KCNJ5 somatic mutations in primary aldosteronism
Yi-Yao Chang, Bo-Ching Lee, Zheng-Wei Chen, Cheng-Hsuan Tsai, Chin-Chen Chang, Che-Wei Liao, Chien-Ting Pan, Kang-Yung Peng, Chia-Hung Chou, Ching-Chu Lu, Vin-Cent Wu, Chi-Sheng Hung, Yen-Hung Lin
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Risk of dementia in primary aldosteronism compared with essential hypertension: a nationwide cohort study
Namki Hong, Kyoung Jin Kim, Min Heui Yu, Seong Ho Jeong, Seunghyun Lee, Jung Soo Lim, Yumie Rhee
Alzheimer's Research & Therapy.2023;[Epub] CrossRef
Study on the Association between Primary Aldosteronism and Cerebrovascular Disease
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Advances in Clinical Medicine.2023; 13(10): 16819. CrossRef
Anticoagulant therapy in patients with atrial fibrillation and chronic kidney disease: Arguments for or against
A. G. Komarova, N. L. Lyakhova, S. D. Covantsev, E. A. Naryshkina, D. V. Slepukhova
Medical alphabet.2023; (25): 14. CrossRef
Hypertension outcomes of adrenalectomy for unilateral primary aldosteronism
Igor Hartmann, Frantisek Hruska, Jan Vaclavik, Eva Kocianova, Zdenek Frysak, Marika Nesvadbova, Zbynek Tudos, Filip Ctvrtlik, Klara Benesova
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Cerebro-Cardiovascular Risk, Target Organ Damage, and Treatment Outcomes in Primary Aldosteronism
Xiao Lin, Muhammad Hasnain Ehsan Ullah, Xiong Wu, Feng Xu, Su-Kang Shan, Li-Min Lei, Ling-Qing Yuan, Jun Liu
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Primary Aldosteronism More Prevalent in Patients With Cardioembolic Stroke and Atrial Fibrillation
Van Nguyen, Tian Ming Tu, Marlie Jane B. Mamauag, Jovan Lai, Seyed Ehsan Saffari, Tar Choon Aw, Lizhen Ong, Roger S. Y. Foo, Siang Chew Chai, Shaun Fones, Meifen Zhang, Troy H. Puar
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Implication of MR Activity in Posttreatment Arterial Stiffness Reversal in Patients With Primary Aldosteronism
Zheng-Wei Chen, Chien-Ting Pan, Che-Wei Liao, Cheng-Hsuan Tsai, Yi-Yao Chang, Chin-Chen Chang, Bo-Ching Lee, Yu-Wei Chiu, Wei-Chieh Huang, Shuo-Meng Wang, Ching-Chu Lu, Jeff S Chueh, Vin-Cent Wu, Chi-Sheng Hung, Yen-Hung Lin
The Journal of Clinical Endocrinology & Metabolism.2022;[Epub] CrossRef
Time-Dependent Risk of Atrial Fibrillation in Patients With Primary Aldosteronism After Medical or Surgical Treatment Initiation
Kyoung Jin Kim, Namki Hong, Min Heui Yu, Hokyou Lee, Seunghyun Lee, Jung Soo Lim, Yumie Rhee
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Pearls & Oy-sters: Cerebral Microbleeds Caused by Adrenocortical Adenoma-Related Primary Aldosteronism
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Cellular Senescence in Human Aldosterone-Producing Adrenocortical Cells and Related Disorders
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Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism
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Heart-Ankle Pulse Wave Velocity Is Superior to Brachial-Ankle Pulse Wave Velocity in Detecting Aldosterone-Induced Arterial Stiffness
Zheng-Wei Chen, Chien-Ting Pan, Cheng-Hsuan Tsai, Yi-Yao Chang, Chin-Chen Chang, Bo-Ching Lee, Yu-Wei Chiu, Wei-Chieh Huang, Yu-Li Lin, Vin-Cent Wu, Chi-Sheng Hung, Che-Wei Liao, Yen-Hung Lin
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Effects of nimodipine combined with betahistine on CRP and other inflammatory cytokines and vascular endothelial function in patients with hypertensive cerebral vasospasm
Xuanwei Liu, Na’na Zhao, Kexue Zeng, Peng Xiao, Pengjie Sheng, Xun Luo, Yulong Wang
Clinical Hemorheology and Microcirculation.2020; 75(3): 279. CrossRef
Associations between primary aldosteronism and diabetes, poor bone health, and sleep apnea—what do we know so far?
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Predicting factors related with uncured hypertension after retroperitoneal laparoscopic adrenalectomy for unilateral primary aldosteronism
WuYun BiLiGe, Chaoqi Wang, JiRiGaLa Bao, Dahai Yu, A Min, Zhi Hong, Xiangbao Chen, Min Wang, Dongmei Wang
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Surgical Approach to Endocrine Hypertension in Patients with Adrenal Disorders
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Original Article

Clinical Study
Factors Associated with Resolution of Hypertension after Adrenalectomy in Patients with Primary Aldosteronism: Wann Jia Loh, Dawn Shao Ting Lim, Lih Ming Loh, Peng Chin Kek; Endocrinol Metab. 2018;33(3):355-363. Published online August 14, 2018; DOI: https://doi.org/10.3803/EnM.2018.33.3.355

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Background

The aim of this study was to investigate the factors associated with resolution of hypertension after adrenalectomy in patients with primary aldosteronism. A secondary aim was to describe our use of the contralateral ratio in adrenal venous sampling (AVS) in the setting of suboptimal successful cannulation rates.

Methods

A retrospective review of patients who underwent AVS followed by unilateral adrenalectomy for primary aldosteronism was performed.

Results

Complete resolution of hypertension and hypokalemia was seen in 17 of 40 patients (42.5%), while a clinical improvement in hypertension was seen in 38 of 40 (95%). Shorter duration of hypertension, mean aldosteronoma resolution score (ARS), and a high ARS of 3 to 5 were associated with resolution of hypertension after adrenalectomy (P=0.02, P=0.02, and P=0.004, respectively). Of the individual components of ARS, only a duration of hypertension of ≤6 years was associated with resolution of hypertension after adrenalectomy (P=0.03).

Conclusion

A shorter duration of hypertension was significantly associated with resolution of hypertension after adrenalectomy in patients with primary aldosteronism.

Citations

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Clinical and biochemical outcomes after adrenalectomy for primary aldosteronism in tertiary and quaternary referral centers: data from SOPRANO study
Luigi Marzano, Claudio Ronco
Hypertension Research.2024; 47(3): 721. CrossRef
Catheter-based adrenal ablation: an alternative therapy for patients with aldosterone-producing adenoma
Fang Sun, Xiaoli Liu, Hexuan Zhang, Xunmei Zhou, Zhigang Zhao, Hongbo He, Zhencheng Yan, Yingsha Li, Qiang Li, Yaoming Li, Jun Jiang, Zhiming Zhu, Hongyun Miao, Zhiyong Li, Ping Wei, Min Long, Xiaoli Chen, Xiaoyun Fan, Wuquan Deng, Yangjie He, Qingbin Lia
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Prognostic models to predict complete resolution of hypertension after adrenalectomy in primary aldosteronism: A systematic review and meta‐analysis
Luigi Marzano, Amir Kazory, Faeq Husain‐Syed, Claudio Ronco
Clinical Endocrinology.2023; 99(1): 17. CrossRef
Long-term outcome success after operative treatment for primary aldosteronism
Omar Picado, Bryan W. Whitfield, Zahra F. Khan, Mohammed Jeraq, Josefina C. Farrá, John I. Lew
Surgery.2021; 169(3): 528. CrossRef
Outcomes of Adrenalectomy and the Aldosteronoma Resolution Score in the Black and Hispanic Population
Gustavo Romero‐Velez, Amanda M. Laird, Manuel E. Barajas, Mauricio Sierra‐Salazar, Miguel F. Herrera, Steven K. Libutti, Michael K. Parides, Xavier Pereira, John C. McAuliffe
World Journal of Surgery.2021; 45(5): 1475. CrossRef
Comparison of cystatin C-based and creatinine-based glomerular filtration rate in the prediction of postoperative residual hypertension in aldosterone-producing adenoma patients after adrenalectomy
Ching-Way Chen, Cheng-Hsuan Tsai, Chi-Sheng Hung, I-Jung Tsai, Yu-Wei Chiu, Chin-Cheng Chang, Kao-Lang Liu, Shih-Cheng Liao, Vin-Cent Wu, Yen-Hung Lin
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Long-term blood pressure outcomes of patients with adrenal venous sampling-proven unilateral primary aldosteronism
Xu Meng, Wen-Jun Ma, Xiong-Jing Jiang, Pei-Pei Lu, Ying Zhang, Peng Fan, Jun Cai, Hui-Min Zhang, Lei Song, Hai-Ying Wu, Xian-Liang Zhou, Ying Lou
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Update on the Aldosterone Resolution Score and Lateralization in Patients with Primary Aldosteronism
Eun-Hee Cho
Endocrinology and Metabolism.2018; 33(3): 352. CrossRef

Review Article

CTNNB1 Mutation in Aldosterone Producing Adenoma: Jian-Jhong Wang, Kang-Yung Peng, Vin-Cent Wu, Fen-Yu Tseng, Kwan-Dun Wu; Endocrinol Metab. 2017;32(3):332-338. Published online September 18, 2017; DOI: https://doi.org/10.3803/EnM.2017.32.3.332

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Discoveries of somatic mutations permit the recognition of subtypes of aldosterone-producing adenomas (APAs) with distinct clinical presentations and pathological features. Catenin β1 (CTNNB1) mutation in APAs has been recently described and discussed in the literature. However, significant knowledge gaps still remain regarding the prevalence, clinical characteristics, pathophysiology, and outcomes in APA patients harboring CTNNB1 mutations. Aberrant activation of the Wnt/β-catenin signaling pathway will further modulate tumorigenesis. We also discuss the recent knowledge of CTNNB1 mutation in adrenal adenomas.

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Sanggu Kim, Preeti Kumari Chaudhary, Soochong Kim
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Wenting Zhuang, Tong Ye, Wei Wang, Weihong Song, Tao Tan
Frontiers in Psychiatry.2023;[Epub] CrossRef
Aldosterone-Regulated Sodium Transport and Blood Pressure
Akaki Tsilosani, Chao Gao, Wenzheng Zhang
Frontiers in Physiology.2022;[Epub] CrossRef
Pathogenesis of Primary Aldosteronism: Impact on Clinical Outcome
Lucas S. Santana, Augusto G. Guimaraes, Madson Q. Almeida
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Molecular Mechanisms of Functional Adrenocortical Adenoma and Carcinoma: Genetic Characterization and Intracellular Signaling Pathway
Hiroki Shimada, Yuto Yamazaki, Akira Sugawara, Hironobu Sasano, Yasuhiro Nakamura
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Somatic mutations of GNA11 and GNAQ in CTNNB1-mutant aldosterone-producing adenomas presenting in puberty, pregnancy or menopause
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Genetics and pathophysiology of low-renin arterial hypertension
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Diagnostic approach to low‐renin hypertension
Silvia Monticone, Isabel Losano, Martina Tetti, Fabrizio Buffolo, Franco Veglio, Paolo Mulatero
Clinical Endocrinology.2018; 89(4): 385. CrossRef
Genetic Characterization of GnRH/LH-Responsive Primary Aldosteronism
Nadia Gagnon, Katia Y Cáceres-Gorriti, Gilles Corbeil, Nada El Ghoyareb, Natasha Ludwig, Mathieu Latour, André Lacroix, Isabelle Bourdeau
The Journal of Clinical Endocrinology & Metabolism.2018; 103(8): 2926. CrossRef

Original Article

Clinical Study
Diagnostic Role of Captopril Challenge Test in Korean Subjects with High Aldosterone-to-Renin Ratios: Jung Hee Kim, Kyeong Seon Park, A Ram Hong, Chan Soo Shin, Seong Yeon Kim, Sang Wan Kim; Endocrinol Metab. 2016;31(2):277-283. Published online May 13, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.2.277

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Background

Diagnosis of primary aldosteronism (PA) begins with aldosterone-to-renin ratio (ARR) measurement followed by confirmative tests. However, the ARR has high false positive rates which led to unnecessary confirmatory tests. Captopril challenge test (CCT) has been used as one of confirmatory tests, but the accuracy of it in the diagnosis of PA is still controversial. We aimed to examine the clinical efficacy of CCT as a post-screening test in PA.

Methods

In a prospective study, we enrolled subjects with suspected PA who had hypertension and ARR >20 (ng/dL)/(ng/mL/hr). Sixty-four patients who underwent both the saline infusion test and the CCT were included.

Results

The diagnostic performance of plasma aldosterone concentration (PAC) post-CCT was greater than that of ARR post-CCT and ARR pre-CCT in PA (area under the curve=0.956, 0.797, and 0.748, respectively; P=0.001). A cut-off value of 13 ng/dL showed the highest diagnostic odds ratio considering PAC post-CCT at 60 and 90 minutes. A PAC post-CCT of 19 ng/dL had a specificity of 100%, which can be used as a cut-off value for the confirmative test. Determining the diagnostic performance of PAC post-CCT at 90 minutes was sufficient for PA diagnosis. Subjects with PAC post-CCT at 90 minutes <13 ng/dL are less likely to have PA, and those with PAC post-CCT at 90 minutes ≥13 but <19 ng/dL should undergo secondary confirmatory tests.

Conclusion

The CCT test may be a reliable post-screening test to avoid the hospitalization in the setting of falsely elevated ARR screening tests.

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Comparison of four confirmatory tests for the diagnosis of primary aldosteronism: Bayesian analysis in the absence of a gold standard
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Case Report

A Case of Adrenocortical Carcinoma Secreting Cortisol, Androgen and Aldosterone.: Jae Ho Choi, Ye Ri So, Yu Chul Hwang, In Kyung Jeong, Kyu Jeung Ahn, Ho Yeon Chung, Seung Ae Yang; Endocrinol Metab. 2011;26(3):239-242. Published online September 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.3.239

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Abstract PDF

Primary adrenocortical carcinoma is a rare tumor, and is characterized by a peri-tumor mass effect and hormone excess signs. Adrenocortical carcinoma most commonly secretes cortisol, but tumors that secrete other adrenal hormones (aldosterone, androgen) are rare. Herein, we report the case of a 70-year-old woman with cortisol, androgen, and aldosterone-secreting adrenal carcinoma. The patient complained of generalized weakness, moon face, and central obesity. On laboratory examination, hypokalemia and metabolic alkalosis was detected. On the hormone test, cortisol, DHEA-S, and aldosterone were all increased. Abdominal CT showed a large right adrenal mass. She underwent right adrenalectomy and the histology revealed the presence of an adrenocortical carcinoma. After adrenalectomy, the patient was treated with hydrocortisone and mitotane.

Citations

Citations to this article as recorded by

A Case of Adrenocortical Carcinoma Secreting Cortisol and Aldosterone
Jiyoon Ha, Min Kyung Kim, Yoon Jin Cha, Seung Kyu Kim, Gi Young Yun, Kwangwon Rhee, Joon Seong Park, Eun-Suk Cho, Chul Woo Ahn, Jong Suk Park
Yeungnam University Journal of Medicine.2012; 29(2): 132. CrossRef

Original Articles

Comparing the Prevalence of Primary Aldosteronism in Hypertensive Diabetic and Non-diabetic Patients.: Yi Sun Jang, Koon Soon Kim, Hye Soo Kim; J Korean Endocr Soc. 2009;24(4):254-259. Published online December 1, 2009; DOI: https://doi.org/10.3803/jkes.2009.24.4.254

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Abstract PDF: BACKGROUND
Primary aldosteronism is the most common cause of secondary hypertension in humans. Its prevalence is estimated to be 10-15% among hypertensive patients. It is also associated with insulin resistance and diabetes mellitus. The aim of our study was to compare the prevalence of primary aldosteronism in hypertensive patients with presence of diabetes mellitus. METHODS: We reviewed retrospectively the clinical records of 104 hypertensive patients for whom we also measured plasma renin activity (PRA) and plasma aldosterone concentrations (PAC). RESULTS: Among 104 hypertensive patients, 44 had diabetes and 60 did not. There were no significant differences in clinical characteristics between non-diabetic and diabetic patients except for age and the number of antihypertensive agents. Patients with target organ damage were more common among diabetic patients. There was no correlation between PAC and the number of target organs damaged. In addition, Four patients from the non-diabetic and two from the diabetic group had a ratio over 30 for PRA/PAC and a PAC of over 15 ng/dL. Two non-diabetic patients and one diabetic patient were found, on abdomen CT, to have an adrenal adenoma. The rest of the patients refused further tests. CONCLUSION: The prevalence of primary aldosteronism in diabetic patients does not differ significantly from that in non-diabetic patients. Therefore, the present routine screening test for primary aldosteronism in hypertensive diabetic patients is not recommended.

The Clinical Implication and Problems of Adrenal Vein Sampling in Patients with Primary Aldosteronism.: Jie Seon Lee, Mi Yeon Kang, Sang Wan Kim, Chan Soo Shin, Seong Yeon Kim, Jin Wook Chung; J Korean Endocr Soc. 2007;22(6):428-435. Published online December 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.6.428

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Abstract PDF

BACKGROUND
Recently, the significance of primary aldosteronism is being recognized due to an increase in its incidence and its complications. However, it is difficult to differentiate primary aldosteronism based on radiological studies as the size of an aldosterone producing adenoma (APA) is small, and nonfunctioning adrenal incidentalomas are common. Adrenal vein sampling (AVS) has been considered as the gold standard for differentiating an aldosterone producing adenoma (APA) from bilateral idiopathic adrenal hyperplasia (BAH). The clinical implications and problems associated with AVS have not yet been reported in Korea. METHOD: Clinical data of 28 patients with primary aldosteronism who had undergone AVS in a hospital from 1995 to 2006 were retrospectively analyzed. RESULT: The study group comprised 13 males (46.4%) and 15 females (53.5%), with a mean age of 44.5 +/- 11.9 years. Clinical data indicated that 19 patients (67.9%) had APA and nine patients (32.1%) had BAH. AVS data demonstrated that 11 patients had APA and five patients had BAH. Two patients were not diagnosed despite successful AVS. AVS was not successful in 10 patients (37.5%); AV catheterization failed in two patients, was not selective in seven patients on the right side, and was not selective in one patient on the left side. CONCLUSION: AVS was helpful in primary aldosteronism patients with inconclusive CT and MRI findings. Selectivity of AVS should be appropriately assessed because of the technical problem of selective catheterization.

Citations

Citations to this article as recorded by

Bilateral Adrenocortical Masses Producing Aldosterone and Cortisol Independently
Seung-Eun Lee, Jae Hyeon Kim, You-Bin Lee, Hyeri Seok, In Seub Shin, Yeong Hee Eun, Jung-Han Kim, Young Lyun Oh
Endocrinology and Metabolism.2015; 30(4): 607. CrossRef
Primary Aldosteronism
Sang Wan Kim
Korean Journal of Medicine.2012; 82(4): 396. CrossRef

Case Reports

A Case of Primary Aldosteronism with Aortic Dissection.: Jung Hyun Seo, Ji Young Kim, Young Sup Kim, Wan Suk Kim, Jin Hyang Shin, Dong Jik Ahn, Yoon Young Cho, Sung Hwan Park, Jae Bok Park, Hyun Dae Yoon, Ji Hyun Lee, Ho Sang Shon; J Korean Endocr Soc. 2004;19(4):452-457. Published online August 1, 2004

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Abstract PDF: Hypertension and atherosclerosis are the most important factors contributing to the development of aortic dissection. Primary aldosteronism is a rare cause of hypertension. The concurrence of aortic dissection is very rare in primary aldosteronism. However, when aortic dissection is found as a life-threatening complication of primary aldosteronism, then the diagnosis of primary aldosteronism is important because the therapeutic intervention can be curative. Only 3 cases of primary aldosteronism with aortic dissection have been reported in the literature. We report here on a case of primary aldosteronism with aortic dissection, which was treated by laparoscopic adrenalectomy. We lowered the blood pressure with antihypertensive drugs and potassium replacement was done to treat the aortic dissection. After stabilization of aortic dissection, we removed his left adrenal mass by laparoscopic adrenalectomy. Postoperatively, the patient's blood pressure has been within normal limits and the serum potassium increased to a normal level without supplementation. The aortic dissection has remained in a stable state

A Case of Adrenocortical Carcinoma with Concurrent Cushing's Syndrome and Primary Aldosteronism.: Chang Won Lee, Hyun Ju Yoon, Won Min Hwang, Jung Kyu Kim, Hoon Sup Koo, Dong Mee Lim, Eu Gene Choi, Moon Jun Na, Do Yeun Cho, Bum Kyeong Kim, In Seok Choi, Keun Young Park; J Korean Endocr Soc. 2004;19(4):446-451. Published online August 1, 2004

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Abstract PDF: An adrenocortical carcinoma is a rare malignancy, which is associated with a poor prognosis. Eighty percent of adrenal tumors are functional, and commonly secrete glucocorticoids alone (45%), glucocorticoids and androgens (45%) or androgen alone (10%). Less than 1% of all cases secrete aldosterone. A case of a 75 year old female patient was experienced, presenting with anadrenocortical carcinoma and associated concurrent Cushing's syndrome and primary aldosteronism. She had complained of left flank pain for 5 months, and also showed clinical features of Cushing's syndrome, hypertension, hypokalemia and a left abdominal mass. An abdominal CT* demonstrated a large left adrenal mass, with necrosis, and a hemorrhage in the left upper abdomen. The plasma renin activity was 0.51 ng/ml/hr, and the serum aldosterone level was increased by 46.4 ng/dL. A low and high dose dexamethasone suppression test revealed no suppression. Histologically, the tumor was diagnosed as a adrenocortical carcinoma. After complete removal of the mass, she received mitotan and prednisolone as adjuvant therapies. Liver and bone metastasis occurred after 6 months of treatment, so was treated with palliative radiotherapy for the bone metastasis

Original Articles

A Clinical Observation on Twelve Cases of Primary Aldosteronism.: Seung Chul Cho, Yong Soo Park, Hwon Gyum Park, Sung Hee Lee, Soon Gil Kim, Woong Hwan Choi, Yu Hern Ahn, Pa Jong Jung, Tae Wha Kim; J Korean Endocr Soc. 2004;19(2):194-202. Published online April 1, 2004

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Abstract PDF: BACKGROUND
Primary aldosteronism describes a group of disorders characterized by long-standing aldosterone excess, with suppressed renin activity, resulting in hypertension and hypokalemia. The protean clinical and biochemical characteristics of this syndrome have important implications regarding its pathophysiology and responsiveness to treatment. METHODS: The cases of 12 primary aldosteronisms, diagnosed at Hanyang University Hospital between 1996 and 1999, were reviewed. RESULTS: The 12 cases were composed of 9 aldosterone-producing adenoma, 2 adrenal hyperplasia and a case of idiopathic hyperaldosteronism. There were 9 women and 3 men. The mean age was 46 yrs (range, 23 to 64 yrs). At the initial visit, the mean blood pressure was 160+/-26/104+/-14 mmHg, and one case of idiopathic hyperplasia had normal blood pressure. The mean serum K+ level was 2.6+/-0.5 mEq/L (range, 1.5 to 3.5 mEq/L). The mean plasma renin activity and plasma aldosterone concentration were 0.4+/-0.4 ng/ml/hr (range, 0.2 to 1.6 ng/ml/hr) and 407.5+/-199.8 pg/mL (range, 225 to 800 pg/mL), respectively. Different steps of diagnostic modalities were applied for the preoperative differential diagnosis. All patients, with the exception of the one with idiopathic hyperaldosteronism, were managed by a unilateral laparoscopic adrenalectomy, as they were all diagnosed under the impression of adrenal adenomas. Ultimately, 9 cases were proven to have adrenal adenomas. One hypertensive case, with hypokalemia, had adrenal hyperplasia, and the case with normotension was found to have adrenal nodular hyperplasia from the pathology. The size of the tumors ranged from 1.4 to 2.4 cm in diameter. Among the 11 cases that underwent an adrenalectomy, the blood pressures in 6 cases normalized after the operation, while the other 5, including the one with unilateral hyperplasia, were still in need of antihypertensives for the control of elevated blood pressures, even after the operation. The other case of idiopathic hyperaldosteronism was managed by the prescription of spironolactone. CONCLUSION: From these, it can be suggested that the clinical diversity of the syndrome, especially in the pathophysiology and response to operation, awaits the development of a better preoperative lateralization procedure

Hypertensive Complications in Patients with Primary Aldosteronism.: Seong Hee Kwon, Yeong Min Cho, Heoung Kyu Park, Do Jun Park, Chan Soo Shin, Kyong Soo Park, Seong Yeon Kim, Bo Yeon Cho, Hong Kyu Lee; J Korean Endocr Soc. 2002;17(1):95-103. Published online February 1, 2002

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Abstract PDF: BACKGROUND
Primary aldosteronism (PA) is believed to be a benign form of secondary hypertension due to the low incidence of hypertensive complications. Recently, several studies have shown that hypertensive complications were common in patients with PA. Therefore, we investigated hypertensive complications in 46 PA patients. METHEODS: Clinical and laboratory features of 46 46 patients were retrospectively analyzed. Hypertensive complications of this group were left ventricular hypertrophy, cerebrovascular accidents, hypertensive nephropathy and hypertensive retinopathy. RESULTS: Hypertensive complications were found in 30 (65.2%) of the 46 patients. The incidence of severe hypertension (higher than or equal to 110 mmHg in diastolic blood pressure) was 17.6%. Left ventricular hypertrophy was found in 26 (56.7%) of the 46 patients. Cerebrovascular accidents were found in 6 patients, and hypertensive nephropathy in 4 patients. The incidence of severe hypertensive retinopathy (higher than or equal to grade 3 in the Keith-Wagener Barker classification) was 17.6%. Of the 35 PA patients who underwent surgical treatment hypertension was found in 18 (51.4%). CONCLUSION: These results indicate that hypertensive complications are common in patients with PA, suggesting that early detection, treatment and close follow-up are necessary in PA.

Aldosterone-Producing Adenoma Diagnosed by Selective Adrenal Venous Catheterization.: Sung Kil Lim, Young Duk Song, Hyun Chul Lee, Kap Bum Huh, Min Kyung Song, Hyun Soo Kim, Kyung Rae Kim, Seok Won Park, Yoo Mi Lee, Yong Suk Yoon, Suk Ho Kwon, Jae Hyun Nam, Sul Hye Han, Do Yeon Lee; J Korean Endocr Soc. 1998;13(4):652-658. Published online January 1, 2001

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Abstract PDF: Primary aldosteronism, not a common cause of high blood pressure, is a syndrome which results from excessively secreted aldosterone from adrenal gland and it accounts for 0.05-2.2% of unselected hypertension. In this case the lesion was not visualized on routine abdominal computed tomographic scan due to its small size. Therefore the selective adrenal venous catherterization & venous sampling was done. As there is some difficulty of sampling from Rt. adrenal vein, the method of measuring aldosterone vs. cortisol ratio of Lt. adrenal vein and inferior vena cava was used to localize the aldosterone-producing adenoma. Clinical symptoms normalized and laboratory data returned to normal range after the surgical adrenalectomy.

Primary Aldosteronism Due to Aldosterone Producing Adenama in the Presence of Contralateral Nonfunctioning Adenama.: Ho Young Son, Eun Ah Kim, Jin Il Kwon, Young Joon Kim, Won Ho Chung, Kyung Rim Choi, Sang Jin Choi, Hye Young Park, Moon Ho Kang; J Korean Endocr Soc. 1998;13(2):223-229. Published online January 1, 2001

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Abstract PDF: Primary aldosteronism is in most cases due either to a unilateral adrenal adenama or to a bilateral hyperplasia of the adrenal cortex. But, a few of bilateral adrena1 tumors in primary aldosteronism also have been reported. In these cases, it is important to differentiate the bilateral aldosterone producing adenomas from the unilateral aldosteronoma in the presence of a contralateral nonhmctioning adenoma for marking a treatment plan. We report a case of primary aldosteronism due to a unilateral aldosteronoma in the presence of a contralateral nonfunctioning adenoma. Abdominal CT sean revealed bilateral adrenal tumors, of which the functioning one was successfully localized using adrenal scintigraphy and selective adrenal venous sampling.

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