Clinical Characteristics and Treatment Outcomes of Primary Aldosteronism in a Tertiary Hospital in Thailand
Keywords:
Primary aldosteronism, Saline infusion test, Adrenal venous sampling, AdrenalectomyAbstract
Background: Primary aldosteronism (PA) is the most common cause of endocrine hypertension, increasing cardiovascular and renal risks. This study aimed to provide comprehensive information on PA patients in Thailand, where data are limited. Materials and A retrospective study of 127 PA patients during 2012 to 2023 from Thammasat University
Methods: Hospital was conducted. Data on clinical and biochemical parameters, screening, confirmatory testing, subtype classification, and treatment outcomes were evaluated.
Results: Fifty patients (39%) had unilateral PA, 50 (39%) bilateral PA, and 27 (21%) were classified as inconclusive subtype. Mean age was 54 years, and 54% were female. All participants had hypertension, with 10% having resistant hypertension. Eighty-three percent had hypokalemia. Median plasma aldosterone concentration (PAC), direct renin concentration (DRC), and PAC/DRC ratio (ADRR) were 21.7 ng/dL, 3.7 μIU/mL, and 5.3 ng/dL: μIU/mL, respectively. The recumbent saline infusion test (RSIT) was the most common confirmatory test, with a 66% positive rate. Adrenal CT scan was performed in all cases. Ninety-two percent of patients underwent adrenal venous sampling, with a 78% success rate. Among adrenal ectomy patients, 53% achieved complete clinical success and 94% achieved biochemical success. Unilateral PA showed higher PAC, ADRR, PAC-potassium ratio, and lower DRC.
Conclusions: Comprehensive PA data supports accurate diagnosis and tailored treatment. Hypokalemia is common in Thai PA patients. Unilateral PA shows a severe phenotype with distinctive hormonal profiles. For confirmatory testing, RSIT is reliable and SSIT promising. AVS, superior to CT for subtyping, is crucial for accurate subtype classification, as nearly all unilateral PA patients achieve complete biochemical remission post-adrenalectomy.
Downloads
References
Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol. 2017;69:1811-20.
Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48(11):2293-300.
Stowasser M, Gordon RD. Primary Aldosteronism: Changing Definitions and New Concepts of Physiology and Pathophysiology Both Inside and Outside the Kidney. Physiol Rev. 2016;96(4):1327-84.
Funder JW, Carey RM, Mantero F, Murad MH, Reincke M, Shibata H, et al. The Management of Primary Aldosteronism: Case Detection, Diagnosis, and Treatment: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-916.
Hundemer GL, Curhan GC, Yozamp N, Wang M, Vaidya A. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol. 2018;6(1):51-9.
Gkaniatsa E, Zverkova Sandström T, Rosengren A, Trimpou P, Olsson DS, Lind M, et al. Mortality in Patients With Primary Aldosteronism: A Swedish Nationwide Study. Hypertension. 2023;80(12):2601-10.
Morera J, Reznik Y. MANAGEMENT OF ENDOCRINE DISEASE: The role of confirmatory tests in the diagnosis of primary aldosteronism. European Journal of Endocrinology. 2019;180(2):R45-R58.
Warachit W, Atikankul T, Houngngam N, Sunthornyothin S. Prevalence of Somatic KCNJ5 Mutations in Thai Patients With Aldosterone-Producing Adrenal Adenomas. J Endocr Soc. 2018;2(10):1137-46.
Suntornlohanakul O, Sakarin S, Kietsiriroje N, Sriplung H. Geographical inequality in service utilization for primary aldosteronism screening: spatial epidemiological study in Southern Thailand. BMC Health Serv Res. 2022;22(1):458.
Kietsiriroje N, Wonghirundecha R, Suntornlohanakul O, Murray RD. Construction of a predictive scoring system as a guide to screening and confirmation of the diagnosis of primary aldosteronism. Clin Endocrinol (Oxf). 2020;92(3):196-205.
WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index. 2020: NIPH; 2022. Available from: https://www.whocc.no/atc_ddd_index/.
Williams TA, Lenders JWM, Mulatero P, Burrello J, Rottenkolber M, Adolf C, et al. Outcomes after adrenalectomy for unilateral primary aldosteronism: an international consensus on outcome measures and analysis of remission rates in an international cohort. Lancet Diabetes Endocrinol. 2017;5(9):689-99.
Monticone S, Burrello J, Tizzani D, Bertello C, Viola A, Buffolo F, et al. Prevalence and Clinical Manifestations of Primary Aldosteronism Encountered in Primary Care Practice. J Am Coll Cardiol. 2017;69(14):1811-20.
Scholl UI. Genetics of Primary Aldosteronism. Hypertension. 2022;79(5):887-97.
Kario K, Chen CH, Park S, Park CG, Hoshide S, Cheng HM, et al. Consensus Document on Improving Hypertension Management in Asian Patients, Taking Into Account Asian Characteristics. Hypertension. 2018;71(3):375-82.
Yoon M, Hong N, Ha J, Lee CJ, Ku CR, Rhee Y, Park S. Prevalence and clinical characteristics of primary aldosteronism in a tertiary-care center in Korea. Hypertens Res. 2022;45(9):1418-29.
Vujačić N, Paunović I, Diklić A, Živaljević V, Slijepčević N, Kalezić N, et al. Biochemical and clinical characteristics of patients with primary aldosteronism: Single centre experience. J Med Biochem. 2020;39(2):240-8.
Umakoshi H, Tsuiki M, Takeda Y, Kurihara I, Itoh H, Katabami T, et al. Significance of Computed Tomography and Serum Potassium in Predicting Subtype Diagnosis of Primary Aldosteronism. J Clin Endocrinol Metab. 2018;103(3):900-8.
Douma S, Petidis K, Doumas M, Papaefthimiou P, Triantafyllou A, Kartali N, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet. 2008;371(9628):1921-6.
Calhoun DA, Nishizaka MK, Zaman MA, Thakkar RB, Weissmann P. Hyperaldosteronism among black and white subjects with resistant hypertension. Hypertension. 2002;40(6):892-6.
Mulatero P, Stowasser M, Loh KC, Fardella CE, Gordon RD, Mosso L, et al. Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents. J Clin Endocrinol Metab. 2004;89(3):1045-50.
Wannachalee T, Caoili E, Nanba K, Nanba A, Rainey WE, Shields JJ, Turcu AF. The Concordance Between Imaging and Adrenal Vein Sampling Varies With Aldosterone-Driver Somatic Mutation. J Clin Endocrinol Metab. 2020;105(10):e3628-37.
Nanba K, Yamazaki Y, Bick N, Onodera K, Tezuka Y, Omata K, et al. Prevalence of Somatic Mutations in Aldosterone-Producing Adenomas in Japanese Patients. J Clin Endocrinol Metab. 2020;105(11):e4066-73.
Young WF, Stanson AW. What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism? Clin Endocrinol (Oxf). 2009;70(1):14-7.
Chayovan T, Limumpornpetch P, Hongsakul K. Success rate of adrenal venous sampling and predictors for success: a retrospective study. Pol J Radiol. 2019;84:e136-e41.
Mulatero P, Bertello C, Rossato D, Mengozzi G, Milan A, Garrone C, et al. Roles of clinical criteria, computed tomography scan, and adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes. J Clin Endocrinol Metab. 2008;93(4):1366-71.
Hashimura H, Hu J, Kobayashi H, Gwini SM, Shen J, Chee NYN, et al. Saline suppression to distinguish the primary aldosteronism subtype: a diagnostic study. Eur J Endocrinol. 2023;188(1).
Suurd DPD, Vorselaars W, Van Beek DJ, Borel Rinkes IHM, Spiering W, Valk GD, Vriens MR. Assessing Outcomes After Adrenalectomy for Primary Aldosteronism - Early is Accurate: Retrospective Cohort Study. Ann Surg. 2022;276(5):929-34.
Kurtz TW, Morris RC Jr, Pravenec M, Lujan HL, DiCarlo SE. Hypertension in Primary Aldosteronism Is Initiated by Salt-Induced Increases in Vascular Resistance With Reductions in Cardiac Output. Hypertension. 2023;80(5):1077-91.
Tang F, Loh LM, Foo RS, Loh WJ, Lim DST, Zhang M, et al. Tolerability and Efficacy of Long-Term Medical Therapy in Primary Aldosteronism. J Endocr Soc. 2021;5(11):bvab144.
Kološová B, Waldauf P, Wichterle D, Kvasnička J, Zelinka T, Petrák O, et al. Validation of Existing Clinical Prediction Tools for Primary Aldosteronism Subtyping. Diagnostics (Basel). 2022;12(11).
Holaj R, Waldauf P, Wichterle D, Kvasnička J, Zelinka T, Petrák O, et al. Adrenal Venous Sampling Could Be Omitted before Surgery in Patients with Conn’s Adenoma Confirmed by Computed Tomography and Higher Normal Aldosterone Concentration after Saline Infusion Test. Diagnostics (Basel). 2022;12(7).
Nanba K, Tsuiki M, Nakao K, Nanba A, Usui T, Tagami T, et al. A subtype prediction score for primary aldosteronism. J Hum Hypertens. 2014;28(12):716-20.
Rossi GP, Crimì F, Rossitto G, Amar L, Azizi M, Riester A, et al. Identification of Surgically Curable Primary Aldosteronism by Imaging in a Large, Multiethnic International Study. J Clin Endocrinol Metab. 2021;106(11):e4340-e9.
Hundemer GL, Leung AA, Kline GA, Brown JM, Turcu AF, Vaidya A. Biomarkers to Guide Medical Therapy in Primary Aldosteronism. Endocr Rev. 2024;45(1):69-94.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Asian Medical Journal and Alternative Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
