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Editorials |7 November 2017

Subclinical Primary Aldosteronism

E. Victor Adlin, MD

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This article was published at Annals.org on 10 October 2017.
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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...
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Adlin EV. Subclinical Primary Aldosteronism. Ann Intern Med. 2017;167:673–674. [Epub ahead of print 10 October 2017]. doi: 10.7326/M17-2237

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

DOI: 10.7326/M17-2237

Published at www.annals.org on 10 October 2017

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2017 American College of Physicians
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