Skip Navigation
Menu
Editorials |7 November 2017

Subclinical Primary Aldosteronism

E. Victor Adlin, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 10 October 2017.
×
FULL TEXT
The prevalence of primary aldosteronism (PA) in patients with hypertension has been widely disputed since the syndrome was first described by Jerome W. Conn in 1956. It was originally believed to be rare, but in 1964 Dr. Conn noted that 2 hallmarks of PA, low plasma renin activity (PRA) and adrenal adenomas, were present in many hypertensive persons. He suggested that the prevalence of PA, rather than less than 1%, might be as high as 20% (1).
Within the next few years, low PRA levels were indeed noted in hypertensive patients (2). Increased mineralocorticoid activity was suspected in these patients because of low salivary sodium–potassium ratios, a marker of mineralocorticoid excess (3), and an exaggerated decrease in blood pressure after treatment with aminoglutethimide, a blocker of adrenal steroid hormone production (4), and with spironolactone, an inhibitor of the mineralocorticoid receptor (5). But urinary aldosterone excretion was normal in these patients, so researchers postulated that the suspected mineralocorticoid excess was caused by an unknown mineralocorticoid or by aldosterone, despite its normal levels.
During the 1970s and 1980s, the conception of PA changed in ways that favored more frequent diagnosis. Many cases were reported with unmistakable features of PA, such as complete cure of hypertension after removal of an adrenal adenoma, but with normal potassium levels and high-normal—but nonsuppressible—levels of aldosterone. When diagnosis no longer required hypokalemia and elevated aldosterone levels, many more cases were discovered (6). The simultaneous measurement...
FULL TEXT
PDF
Not Available
Citations
Citation

Adlin EV. Subclinical Primary Aldosteronism. Ann Intern Med. [Epub ahead of print 10 October 2017]167:673–674. doi: 10.7326/M17-2237

Download citation file:

© 2019

×
Permissions

Published: Ann Intern Med. 2017;167(9):673-674.

DOI: 10.7326/M17-2237

Published at www.annals.org on 10 October 2017

©
2017 American College of Physicians
2 Citations

Related Articles
Hypokalemia in the Hypertensive Patient: With Observations on the Incidence of Primary Aldosteronism
Annals of Internal Medicine; 66 (6): 1079-1090
Primary Aldosteronism Versus Other Forms of Hypertension Associated with Hypokalemia.
Annals of Internal Medicine; 60 (2_Part_1): 331
Diagnosis and Treatment of Primary Hyperaldosteronism
Annals of Internal Medicine; 121 (11): 877-885
Disparate Patterns of Aldosterone Response During Diuretic Treatment of Hypertension
Annals of Internal Medicine; 87 (5): 558-563
View MoreView Less

Journal Club
Review: Aldosterone blockade reduces mortality in patients with left ventricular dysfunction
Annals of Internal Medicine; 151 (4): JC2-9
View MoreView Less

Related Point of Care
Hypertension
Annals of Internal Medicine; 170 (9): ITC65-ITC80
Hypertension
Annals of Internal Medicine; 161 (11): ITC1
Hypertension
Annals of Internal Medicine; 149 (11): ITC6-1
View MoreView Less

Related Topics
Adrenal Disorders
Cardiology
Coronary Risk Factors
Endocrine and Metabolism
Endocrine Cancer

Adrenal Disorders, Cardiology, Coronary Risk Factors, Endocrine and Metabolism, Endocrine Cancer.

PubMed Articles
Lanthionine and Other Relevant Sulfur Amino Acid Metabolites: Detection of Prospective Uremic Toxins in Serum by Multiple Reaction Monitoring Tandem Mass Spectrometry.
Methods Mol Biol 2019;2007():9-17.
Retinal and choroidal vasculature changes associated with chronic kidney disease.
Graefes Arch Clin Exp Ophthalmol 2019.
View More

Results provided by: PubMed

CONTINUE WITH LIMITED ACCESS
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
acp link acp
silverchair link silverchair

Copyright © 2019 American College of Physicians. All Rights Reserved.

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

Privacy Policy

|

Conditions of Use

This site uses cookies. By continuing to use our website, you are agreeing to our privacy policy. | Accept
×

You need a subscription to this content to use this feature.

×
PDF Downloads Require Access to the Full Article.
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×
Access to this Free Content Requires Users to be Registered and Logged In. Please Choose One of the Following Options
Annals of Internal Medicine
To receive access to the full text of freely available articles, alerts, and more. You will be directed to acponline.org to complete your registration.
×